One of the most severe epidemics of modern society, which is often underestimated against the background of other diseases, is the human immunodeficiency virus (HIV). For several decades, HIV has been a major threat to the health of millions of people around the world. The virus, by entering the body through blood or sexual contact, effectively infects immune lymphocytes (Del Amo et al., 2020). As a consequence, a person’s immune ability to resist other infections drops dramatically. Such a patient, if not adequately treated, dies not from HIV but from an opportunistic infection. For a long time, HIV was thought to be a disease unique to homosexuals and drug addicts. However, years of research on the virus have shown that anyone, regardless of racial, sexual, or even cultural preference, has the same chance of contracting the infection. Understanding the epidemiological nature of HIV has forced clinicians to seek mechanisms to contain the disease quickly. One of the most apparent avenues was prevention education, where people were informed about the disease and told how to protect themselves from it. The next level of containment was the development of antiretroviral therapy in 1996, which allowed already sick people to effectively mask their diagnosis and live as if they were healthy (Forsythe et al., 2019). HIV therapy has a very important property, namely, the containment of new cases. An HIV-positive patient on therapy is unlikely to transmit the infection to his or her sexual partner or future child. As a consequence, such therapy is effective in curbing epidemiological growth. This paper evaluates the possibility of using mathematical modeling to identify an equation suitable for the spread of HIV. With knowledge of such an equation, it becomes possible to predict new cases. The first thing to say is that in any epidemiological disease, there is a distinction between new cases and current cases. In the case of HIV, it should be understood that the infection with this disease is chronic, which means that the patient will live with the diagnosis for life. Rare cases have been reported in which patients have fully recovered from HIV, so this is not addressed in current work (Molteni, 2021). Only new cases of infection are studied in this simulation since this is what allows us to assess the dynamics of the epidemic. To determine the equation describing the HIV epidemic, it was chosen to look at historical data. Specifically, Roser and Ritchie provided data on the global spread of new HIV cases over the past thirty years, since 1990 (Roser & Ritchie, 2019). This data set contains thirty rows and is presented in Appendix A; all data are in millions. Using MS Excel to graph these data, it became clear that the form of the appropriate equation had to be polynomial because the graph behaved dynamically. A built-in regression function was then used with a choice of trend line type. It is worth saying that regression is a statistical model that allows us to determine the curve equation that best fits the current data set. The indicator of the fit of the constructed model to the data set is the parameter R2, the coefficient of determination (LibreTexts, 2021). This coefficient reflects how much variance of all data was covered by the current model. Accordingly, the higher this coefficient, the better the equation fits the data set. Specific Equation The built-in regression function with polynomial trend line selection produces a specific regression equation, as shown below. One can perfectly see that this equation is polynomial in that it contains five terms of different orders. Furthermore, this equation cannot be simplified any further, which is also a property of polynomial functions. The greatest degree of the terms in this equation is four, and the other terms are also present, including the free coefficient. We can also see that some of their coefficients contribute positively to the overall equation, while three of the terms contribute negatively.
Graphical Representation
A graphical representation of the simulated equation was constructed using MS Excel. The figure below shows both the initially collected data set and the polynomial line. In addition, the regression equation is plotted, and the value of the R2 coefficient is shown. As noted earlier, this coefficient corresponds to the degree of fit between the model and the data set. The value of 0.9869 shows that about 98.69 of the total variance of the initial data set was covered by this equation (LibreTexts, 2021). In other words, this is an extremely good result that shows the reliability of the equation.
Forecast
As can already be seen from the above graph, the HIV epidemic was gaining momentum until 1996, after which a slow decline in new cases began. One cannot assume that this is due to the low availability of medicine because, on the contrary, an increasing number of potential patients have been receiving medical care over the past decades. Consequently, an important epidemiological event was accomplished in 1996 to reverse the trend in the spread of HIV. As already mentioned, this was due to the discovery of antiretroviral therapy, which was the salvation of humanity (Del Amo et al., 2020). Fewer and fewer people have been infected with HIV, even in contact with the patient. Mathematical prediction makes it possible to predict what development of the disease should be expected in the following years. In particular, it is well seen that the trend has been downward since 1996, which means that if the current trend continues, we can expect the number of new cases to continue to decrease in the coming years. Increased access to medicine, the expansion of antiretroviral therapy, and the development of new HIV vaccines will also contribute to this decrease. Interestingly, substituting years before 1990 also results in a decrease in the total number of new cases, as the graph shows. From this boundary, however, it is inappropriate to talk about an increase in the availability of medicine. On the contrary, the decrease in the number of cases over time shows that medicine was increasingly less developed, and diagnostic methods were not as widely used. Substituting the value of 2022, the current year, into the above equation yields several 1.33 million, which is the projected number of new HIV cases this year. Subsequent extrapolation reveals that the equation goes into negative numbers by 2026. Hence, the model predicts that there will be no more new HIV cases in the world by 2026 because therapy will be ubiquitous. This extrapolation is too unambiguous and does not take into account additional factors, but it allows us to trace the general trend in the development of the epidemic.
The Late Phase of HIV type 1 replication involves the assembly of Gag proteins with the plasma membrane of hematopoietic cells. The binding is enhanced by the matrix domain of Gag. The matrix domain is also involved in cleaving Gag into the matrix, capsid, and nucleoplasm particles. The assembly of Gag proteins and plasma membrane takes place at lipid rafts to form immature virions. However, Phosphotidylinoistol 4,5-biphosphate has been found to carry out the same role played by matrix. Pl(4,5)Pz can trigger myristyl switch. In addition to it enhancing membrane anchoring, it also plays a crucial role in suggesting appropriate ways for Gag to membrane rafts.
Pl(4,5)P2 contains two long-chain fatty acids that play the role of promoting micelle formation. Cellular form of Pl(4,5)P2 also contains stearate at position 1 and arachidonate at position 2 of glycerol group. Substoichiometric addition of amounts of Pl(4,5)P2 species in myristoylated MA and myristoylated MA lead to stern broadening in the 1H-14N (HSQC) NMR spectra. It also led to the signals for NH groups to broaden beyond detection (Bhardwaj, 56).
Myristyl is very crucial in the replication process of Late phase HIV type 1, however, the mutation process can hamper with myristoylation process leading to inhibition of membrane binding in vitro. This can result in Gag targeting cytoplasm and other intercellular membranes instead of the plasma membrane. Occasionally, Gag molecules are known to assemble and bud from the plasma membrane via indirect routing (Bhardwaj, 81). On the other hand, in primary macrophages budding was found to be occurring in multivesicular bodies.
According to the research carried out, localization of Gag molecules in virus assembly depends on Pl(4,5)Pz. Pl(4,5)Pz also plays a significant role in marking membranes of specific cellular proteins. Depletion of Pl(4,5)Pz hampers virus assembly and results in piling of Gag molecules at membranes of late endosomes and MVBs (21). On the other hand, induction of Pl(4,5)Pz filled with endosomes redirects Gag into targeting endosomes or MVBs. Induction also stimulates intravesical budding. The replacement of MA with membrane-binding N end Fyn kinase results in a reduction of virus sensitivity in assembling to Pl(4,5)P2 that results in manipulation.
In the study of the structure of di-C4-Pl(4,5)P2:myrMA Complex, it was observed that myrMA was absent. The binding of di-c4-Pl(4,5)P2 was found to be because of the elimination of the myristyl group. Exposure of myristate was found to be induced by an allosteric mechanism. This was shown by the binding that took place between di-c4-Pl(4,5)P2 and myrMA (Bhardwaj, 77). The binding of di-c4-Pl(4,5)P2 and myrMA resulted in structural changes of more. From the structural changes observed on myrMA, it was deduced that myristate exposure was triggered by an allosteric mechanism. In the process, Pl(4,5)P2 binding stimulates slight significant changes in the beta-hairpin that is responsible for the observant changes in the orientation of the helical structure.
The specific binding of Phosphatidylinositide is enhanced by hydrophobic and electrostatic interactions. Its lipids facilitate intracellular interactions that enhance the identification of organelles. Various groups of proteins interact freely with the diverse groups of phosphatidylinositides with the aid of lipid molecules. The studies that have been carried out show that HIV-1 attacks and affects the phosphatidylinositides signal system hence proving that Pl(4,5)P2 plays a crucial role in enhancing the attachment of Gag to the PM.
Present studies also show that Pi(4,5)P2 can act as an allosteric trigger for myristate exposure. It also acts as a direct membrane anchor by providing mechanisms for attaching Gag to membranes enriched with Pl(4,5)P2.
Neurodegenerative diseases have been learned to be increasing with the aging of the population. However, their link with genomic mutation is too minute; this is because of the finding that mutation causes slow changes in neural functions. The majority of neurological disorders have been associated with environmental changes. However, scientists have managed to come up with pluripotent stem cells device to enable them to solve neurological problems experienced.
The study of pluripotency
The study of pluripotency has its origin from the study of cell biology and cloning in mammals. According to a pluripotency study, primitive embryonic cells from mammals such as mice and monkeys can be used in making whole organisms. However, the generation of animals to be used in the study of neurological diseases in humans has proved difficult. This is because of difficulties in matching the genetic composition of the models with the real organisms.
In addition, the majority of the animals used in the production of models lack some chromosomes present in human beings, for instance, the mouse lacks chromosome 21. To overcome the problem of animal model limitations, everlasting neural cells are used in the culturing of tissue models. However, the use of immortal cells also poses a challenge to the treatment of neurological disorders. For instance, in the use of immortal cells in the production of culture tissues, abnormal cells may be produced. In addition, the disease-expressing genes may be over-expressed.
According to the research carried out, the generation of iPS cells can aid in generating diverse neurons and neural support cells like those found in the brain and the spinal cord, hence enhancing the containing of neurological diseases. In addition, the development of iPS cell models will be of great advantage to both neurodegenerative and neurodevelopmental diseases. An example of neurodevelopmental disorder is fragile X syndrome.
Fragile X syndrome is an inheritable form of mental impairment. It is a result of the increase of the trinucleotide sequence. During the expansion of trinucleotides, there is a loss of FMR1 protein that results in developmental variations in the cerebral cortex (Sidhu, 67). Dendric cells in the region of the brain that contains extensive trinucleotides are immature in shape. The lost FMR1 gene is only observed in embryonic stages and silenced in adulthood.
X-chromosomes also portray some syndromes such as Rett’s syndrome. Rett’s syndrome is usually caused by impulsive mutations. Most of the people portraying this disorder are female; this is because Rett’s syndrome results in male fetuses’ death. The severity of Rett’s syndrome in women is evidenced by the specific changes in genes loci and inactivation of x-chromosome shapes.
iPS models will also be of great advantage in Down’s syndrome. Down’s syndrome is a result of the trisomy of chromosome 21. Through iPS, human fetal NPCs have been found to develop Down’s syndrome that can be used in the reprogramming process.
Spinal muscular atrophy is also an example of an autosomal recessive disorder that causes infantile death. It is a result of the loss of SMN1. Patients suffering from spinal atrophy have been found to lose SMN protein, which results in cell demise and deterioration of muscles. Other diseases that can be managed by the implementation of iPS include Huntington’s disease, Parkinson’s disease, and Amyotrophic lateral sclerosis (Yildrim, 173).
Huntington’s disease is caused by the repetition of expanded CAG in exon 1 of HTT. The severity of this disease is expressed by the aggregation of proteins within the nucleus of certain neurons. Parkinson’s disease is depicted by the production of neurons that produce dopamine throughout the brain. On the other hand, Amyotrophic lateral sclerosis is an adult sporadic genetic disease that leads to paralysis and atrophy of muscles. Although iPS contributes immensely to the production of neurological models, it cannot manage to produce all cells of neurological lineages. Due to this, neurological diseases cannot be managed completely.
Works cited
Bhardwai, Nitin. A Comprehensive Bioinformatics Study of the Interaction Between Peripheral Proteins and Membrane. Chicago:ProQuest, 2007. Print.
Sidhu, Kuldip. Frontiers in Pluripotent Stem Cells Research and Therapeutic Potentials. New York: Bentham Science Publishers, 2012. Print.
The HIV/AIDS epidemic in Cameroon remained to be a pressing issue for policymakers and the healthcare system. The most recent data suggested that in 2004 5.1% of the population had been infected. This was the largest percentage in the region of West and Central Africa. The HIV/AIDS issue was complicated by the fact that at the moment of this research, there was no cure and the only way of addressing the infection spread was through prevention and ensuring that people engage in behaviors that do not put them under the risk of contracting HIV/AIDS. In this paper, the author argued that FBOs are the best choice for implementing the strategies focusing on prevention because they had the infrastructure and resources to change the socio-cultural values of communities, which was what needed to be done to reduce the prevalence of HIV/AIDS cases in Cameroon. Apart from the health-related issues, caused by HIV/AIDS, the social stigma associated with the disease decreases the quality of life of the infected individuals. FBOs were one of not many forces that could be leveraged when addressing the HIV/AIDS epidemic because ministries and churches have a strong global impact, while simultaneously being closely linked to local communities. Moreover, in Cameroon, religious organizations were responsible for many of the state’s healthcare facilities. The findings from the review of the literature suggested that not many peer-reviewed articles on the topic of FBOs and their contribution to the reduction of HIV/AIDS cases exist, which was an issue considering that a typical Cameroonian family values religion as one of the essential practices. Hence, the government of Cameroon and NGOs had to support FBOs in their battle against the epidemic. Most importantly, one should understand that raising awareness and promoting education as a sole tool in the fight against HIV/AIDS was not enough, it is an essential part of the strategy but not the sole element of it. There was a need to implement model laws to protect people, who live with HIV/AIDS and a need to establish practices that reduce MTCT.
Introduction
Cameroon still has a relatively high HIV/AIDS infection rate of 3.8%. The epidemic is still a global problem and treatment efforts should focus on Cameroon because it was the hardest-hit region in the west and central Africa in 2004 (UNAIDS/WHO, 2004; Plan, 2019). It is one of the world’s least prosperous countries in terms of progress towards the UNAIDS 90-90-90 targets of Population-based HIV Impact Assessment, despite all attempts to mitigate HIV/AIDS risks (PEPFAR Progress Reports, 2018). As per my research findings, this is because the government has not given religion the place it deserves in its fight against HIV/AIDS (O’Donnell, 2018). The problem of HIV/AIDS in Cameroon hinders the state’s opportunity for achieving sustainable development because it burdens the health system and is accompanied by stigma that people living with this virus face, which can only be addressed by supporting the FBOs, promoting the knowledge of adequate behaviors, and implementing model laws.
The focus of this study is former Southern Cameroon. The location that is the focus of this research has one of the highest rates of HIV infection cases by region. Southern Cameroonians are poor, marginalized, and presently undergoing unimaginable political upheavals. The CBCHS, the FBO that has partnered with the government to fight against HIV/AIDS because these organizations originated here and are well-grounded in those communities. Figure 1 shows the distribution of HIV by regions in Cameroon.
Figure 1. Cameroon official statistics of HIV/AIDS prevalence rate among adults
A well-known researcher of religion, spirituality, and health defines faith as the practices and rituals related to the sacred (Koenig, 2009). These practices and traditions are prevalent in Islam, Christianity, and indigenous beliefs in southern Cameroon (Schilder, 1988). The HIV/AIDS information kit, jointly produced by UNICEF, UNAIDS, and the World Conference of Religions for Peace, urges leaders of various faith communities to use their influence, moral compass, and resources to alter the course of the epidemic (UNICEF, 2003).
For example, in one report, it is stated that “the church calls on men and women of goodwill to put all hands-on deck to wage an all-out war against this pandemic, by taking part in public sensitization, information, and education activities, without hesitating to fall back on our cultural and spiritual values” (NECC, 1999, p. 55). This quote implies that Cameroon’s cultural and spiritual values are indispensable in all HIV/AIDS discussions.
Faith-based groups in underserved neighborhoods have been essential catalysts of health and wellness campaigns (Campbell et al., 2007). Faith-based organizations (FBOs) include churches, mosques, and community-based organizations that use faith to spread moral values (Stewart, 2019). The Cameroon Baptist Convention Health Services (CBCHS) is a prominent FBO. It is a robust health care organization fostering HIV care and treatment initiatives in sub-Saharan Africa. Moreover, CBCHS is a critical partner of the Cameroon government working on the prevention of mother-to-child HIV transmission (Tih, 2018). CBCHS was slow in terms of embracing evidence-based practices (EBPs), making their work less effective, despite all the efforts to eradicate HIV/AIDS. Incorporating EBPs into new and existing FBO programs can improve their effectiveness (Terry et al., 2015).
FBOs’ importance in combating HIV/AIDS has been very much appreciated because churches have demonstrated that FBO credibility, influence, and strength in the community can positively change people’s behavior (Ochillo et al., 2017). The FBOs are invaluable actors in HIV elimination. They need more funding to focus on delivering much-needed lifesaving help to as many patients as possible (Ochillo et al., 2017). Many other African countries have used FBOs in the successful management of HIV/AIDS. For instance, Uganda is one of earliest and highly compelling national success stories in the world, where the president used FBOs to combat the spread of HIV (UNAIDS, 2004). In this research, I will use interviews with key informants as the basis for gathering information on FBOs impact. In addition, I will use information gathered from social media and literature on the topic, including reports from NGOs and case studies from other African states.
Engaging organizations with the capacity to reach large numbers of underprivileged individuals, especially those with health challenges, and the opportunity to impact individuals and their communities is a significant step in combating HIV (Schoenberg, 2017).
The CBCHS originated in southern Cameroons, and it is very popular, which is why this organisation is included in this research. Southern Cameroon has one of the highest numbers of HIV cases in this region, which is why this organization was selected for this research. Cameroon’s citizens are poor, marginalized, and presently undergoing political upheavals. This paper emphasizes that if FBOs incorporate EBP in their services, they will become the most influential institutions promoting preventive behaviors for HIV/AIDS in Southern Cameroon. One of the reasons for focusing on FBOs instead of government institutions is that the government has lost its credibility and moral authority to manage public and charitable institutions due to poor governance, corruption, and ineptitude (O’Donnell, 2018).
In this research, I ask the question of whether FBOs are the best solution for addressing the issue of HIV/AIDS in Cameroon. The premise is that for a Cameroonian society, FBOs are the important institutions that have an impact on society as religion is highly respected in Cameroon. Moreover, the government is not equipped to combat the spread of HIV because of corruption and improper management of resources. Hence, with this research, I ask the question of FBOs’ capability to address the HIV/AIDS epidemic in Cameroon considering the CBCHS’s use of evidence-based practices during their ceremonies and preaching for preventing behaviors that put a person at risk of contracting HIV.
Outline
This paper is structured with a goal of explaining the background information on Cameroon, the socio-cultural, economic, and political environments, which will be done in the section “Motivation.” Next, I will explain the methodology of this research, including how I selected the literature for this study and what additional sources of information I used. Next, in the section dedicated to the literature review, I will focus on the best practices and case studies, and I will explain why FBOs are suitable for the intervention I propose. In the final sections, I will summarize this paper, discuss the strategies that one can use in Cameroon to address the HIV/AIDS epidemic, and reflect on the experiences I gained with this capstone.
Motivation
The desire to research the religious aspects of managing HIV/AIDS in Southern Cameroon is personal. It was typified by Albert Einstein, who argued that “science without religion is lame, and religion without science is blind” (Bednar, 2016, p. 217). I have seen miracle healings that doctors cannot attribute any scientific rationale to in my job as a bedside registered nurse. If no scientific explanation exists, the interplay of both science and faith takes precedence. These inexplicable healings lead one to believe that religion contributes to holistic recovery. It is crucial for healthcare professionals and pastoral counselors to work together for holistic treatment. Secondly, the unique nature of the HIV pandemic is worth the research. It “hits adults in the prime of their lives, thus depriving families, communities, and the entire nation of their most productive citizens” (Niebuhr et al., 2004, p. 10).
Study Area
Brief History of Cameroon
Cameroon has a population of 26 million, with a surface area of 183,521 square miles, is located west of central Africa (World Population Review, 2020). Its neighbors are the Gulf of Guinea, in the southwest; Nigeria in the northwest; Chad in the North; the Central African Republic in the Southeast; with Congo Brazzaville, Gabon, and Equatorial Guinea all located south of Cameroon. Yaoundé is the capital of Cameroon, with Douala being its largest city (Washington Post, 2005). The country has ten administrative regions and eight of them are French speaking, while two are English speaking.
Figure 2. Cameroon’s locationFigure 3. Map of Cameroon
Political, Economic, and Social Development
Cameroon is governed by the 1972 constitution, which has been undermined by its various amendments (Malah, 2009). The president of Cameroon, whose name is Paul Biya, was born in 1933. He became president in 1982 and is still the president now at 87. He has been in power for 38 years (Drew, 2019). In 2008 he persuaded parliament to revise the constitution that made him the head of state for life. The revised constitution says, “the President of the Republic shall be elected for a term of office of seven years. He shall be eligible for re-election” (Cameroon 1972 rev., 2008, p. 6). Malah is therefore correct when she states that, “in the absence of any limits or restrictions on the amendment of a constitution, it is challenging for such a constitution to promote constitutionalism, respect for the rule of law, democracy, and good governance” (Malah, 2009, p.1).
The president appoints the head of government, who is the prime minister. The bicameral legislature consists of 180 seats in the national assembly and 100 seats in the Senate. These 100 seats are distributed equally among the ten regions. Of that number, 70 go through elections while the president of the republic appoints 30. The ruling political party, the Cameroon People’s Democratic Movement (CPDM), controls 148 of the National Assembly’s 180 seats and 81 of the Senate’s 100 seats (World Bank, 2020). Therefore, Cameroon is impaired in terms of its democracy — a situation often described as “the incapacities of governmental institutions to reflect the real values and ideas of the citizens” (Tronto, 2013, p.17).
As of 2015, before the strike in Cameroon, Cameroon had an index of 0.518 %, a ranking of 153 out of 188 countries, as evidenced in the Human Development Index (HDI), which calculates a country’s health, education, and income as indicators of development, (World Bank, 2015). This index placed Cameroon as a lower-middle-income country due to its dysfunctional educational system, poverty, mismanagement, and inadequate healthcare.
These political and social issues, coupled with its dysfunctional judiciary, and a very primitive infrastructure, weigh heavily on the former Southern Cameroons and propels it into abject poverty. Tertiary education focuses on conventional academic disciplines are inferior to modern times (World Bank, 2015). In November 2016, Southern Cameroon lawyers, teachers, and university students, who were frustrated with the existing system, went on a peaceful strike, protesting the adulteration of their Anglo-Saxon culture by the French culture (Foretia, 2017). Since then, Southern Cameroon has not known peace as tensions between the anglophone minority and the central government erupted into violence, with both sides committing atrocities (Chinje, 2017). More than 500,000 people are internally displaced, and approximately 400 civilians and over 200 military, gendarmerie, and police officers have died. Cameroon suffers from poor governance, which hinders its growth and investment capacity (World Bank, 2018).
Cameroon is a lower-middle-income country endowed with rich natural resources. Oil and gas are mainly located in Southern Cameroon and account for 40% of the country’s exports (World Bank, 2018). Cameroon had a significant economic crisis in the 1980s, which still affects its population to date. Rampant corruption has significantly reduced Cameroon’s economic development and adversely affected industry, employment, investment, economic growth, and development. In any civilization, corruption is detrimental to economic progress. Rampant corruption, coupled with government ineptitude and mismanagement, has stifled Cameroon’s economic growth and impoverished its citizens (Sumah, 2018).
Similarly to other public domains in Cameroon, healthcare is in a poor state for a country that has been independent since 1960. Access to quality healthcare is a nightmare due to the cost of services, systemic corruption, long distances to facilities, primitive infrastructure, limited trained personnel, and overt bribery or corruption. The government’s inability to satisfy its people is apparent in the fight against HIV/AIDS.
The current 28,000 newly infected persons with HIV far outstrip the 24,000 reductions in HIV-related morbidity and mortality (UNAIDS, 2018). The Cameroon government does not take serious steps to ensure that its citizens know their HIV status and “without a supportive partner, country policy environment (the presence of formal and informal regressive fees for health services), U.S. government HIV investments cannot be as effective or efficient, thereby slowing or stalling progress” (PEPFAR annual report, 2018, p.9). Cameroon stands out in central Africa as a glaring example of a country that lacks collaboration as well as the accountability of its partner governments and communities. Figure 4 below shows Cameroon’s position in 2018 among other states when comparing the percentage of people aware of their HIV status, treated or virally suppressed.
Progress toward UNAIDS 90-90-90 targets in adults in PHIA (Population-based HIV Impact Assessment) countries.
Figure 4. HIV/AIDS statistics in Africa
Many non-governmental organizations (NGOs) have stepped into the fight against the prevention of HIV infections. The most prominent is the CBCHS, a robust health care organization now working to reduce and, hopefully, improve HIV care and treatment in sub-Saharan Africa (Tih, 2018). The CBCHS is a faith-based-organization (FBO), a subset of NGOs. These FBOs are religious organizations existing in communities with religious and educational missions that provide social services and work autonomously but collaborate with at least some groups. Such organizations are sometimes called faith-based social service coalitions or religious non-profit organizations (Ebaugh, Chafetz & Pipes, 2006). The FBO (CBCHS) was established more than 60 years ago, in the small town of Donga-Mantung in the North West region of Cameroon. Today, this organization has branches in seven regions of the country and offers services countrywide. Figure 5 below shows the spread of CBHS in Cameroon.
Figure 5. CBCHS in Cameroon
The CBCHS employs 4000 people and has years of experience managing externally funded projects (Tih, 2018). One of the most up-to-date CBCHS centers is the Yaoundé Resource Centre, which provides testing, capacity development, and project management tools and services.
Although this organization flourishes in the health sector and has crossed several milestones, they face many challenges, such as poverty, unreliable communication networks, inadequate infrastructure, and a chronically unskilled workforce as Figure 6 illustrates.
Figure 6. Challenges CBCHS faces in Cameroon
Methodology
The literature review was conducted using the University’s online library resource, and the keywords for the search were “Cameroon HIV/AIDS,” “the epidemic of HIV/AIDS in Africa,” “faith-based organizations HIV/AIDS.” The final keyword, in particular, generated a large number of search results. Still, a very limited number of articles were written about Cameroon, limiting the applicability of findings since Cameroonians are religious people, and considering the corruption within this state, FBOs play a role in providing healthcare services and support to the communities.
This paper’s inclusion criteria include the relevance of the study to the research question, the publication date, which had to be within the last ten years, and the studies that described the best practices and success stories of other states were preferred. Governmental reports and case studies were included in particular because these allow reviewing empirical data, such as the number of cases before and after and specific steps in terms of policies and strategies that allowed FBOs to succeed in the region. The exclusion criteria were the origin of these reports and case studies, and papers that were not about Africa were excluded.
In total, I reviewed over a hundred articles and publications from NGOs and compiled the information from these resources into a literature review. In addition to the literature review, I communicated with the NGOs and governmental organizations that work towards reducing the number of infection cases in this state used my personal experience and data obtained from communications with people living in Cameroon.
Therefore, this research project draws on 2019-2020 data gathered from the literature review, case study reviews, primary informant interviews, and social media conversations to explore the integration of evidence-based practices (EBPs) on faith-based organizations (FBOs) programs as a safer response to HIV prevention in former West Cameroon.
I was born and raised in Cameroon, I participated in Baptist church services for three months while assisting my late sister in one of the CBCHS hospitals in Mbingo in the Northwest region. I also helped her brother during eye surgery in the Baptist hospital, Mutengene, in the southwest region. I was treated in government hospitals whenever I needed medical care. I therefore have some prior knowledge about how Baptist and government hospitals in this region function.
Critical Literature Review (CLR)
A scoping literature analysis was used to understand how FBOs handled HIV prevention in Cameroon properly. The most up-to-date literature released by September 2020 was selected from various databases. Sixty articles were reviewed and out of these, 15 topics were classified as key themes. A total of 75 scholarly articles were identified. All the search results were rechecked, and those who did not address evidence-based practices in FBOs, faith-based HIV preventive services, HIV in Cameroon, the case study of EBP in HIV therapy were eliminated. This repository of knowledge will be applied to determine if the government abdicated its responsibilities by relegating HIV preventive measures to FBOs.
Case Study Reviews
Multiple case studies were scoped by examining best practices from 18 countries in Central and West Africa, as outlined in the Aware HIV/AIDS 2011 project (AWARE, 2011). These studies offered an in-depth and thorough investigation of EBP and the related contextual information. They clarified the understanding of this complex issue of EBP on HIV prevention. Though there is no unique definition of a case study, Gustafsson (2017) and Woods (1980), in their research, define it as an intensive and systematic examination of a group, community, or some other social unit, where the researcher examines detailed data relating to several variables.
Key Informant Interview
An open and ongoing communication line with some members of the National AIDS Committee, NGOs, and employees in government-owned hospitals and hospitals run by FBOs in Cameroon has been maintained throughout this research initiative. Open-ended, unstructured interviews with key informants in Cameroon have also been conducted. Unstructured interviews involve the interviewer and researcher in a dialogue about the issue in reaction to the interviewer’s open-ended questions (Streubert & Carpenter, 1999).
The interview subjects were a small group of people who were likely to provide needed information, ideas, and insights on the research topic. Five analysis questions pertinent to this research project’s fundamental concerns were used. A review guide that lists the key issues and topics for each study issue has been prepared. Fifteen primary informants were chosen based on their experience and expertise. The research subjects were interviewed, and their responses were evaluated. All interviews were conducted with the full consent of the research participants.
Social Media
Data were obtained about corrupt practices currently taking place in Cameroon churches. The data were used to understand public opinions on what people think about eradicating HIV patients’ user fees. Two hundred randomly selected participants from the author’s alumni association volunteered to participate in an online debate, hosted by the author, about Cameroon HIV patients. This social media initiative was instrumental in providing gray literature for this research project.
Limitations to the Methodology
The research time was too short for a researcher to obtain adequate participant feedback. There was inadequate time to verify if the PEPFAR imposed government and FBOs laws passed in April 2020 on no user fees were effectively respected. Cameroon is currently under a political crisis. This crisis comes with many repercussions like unwarranted police arrests, mass killings of citizens by both parties, ghost towns imposed by both the government forces and the secessionists, and little or no internet services, thus limiting communication with the rest of the world. Communication was, therefore, a significant handicap, and even when the internet was restored, effective reliable communication was spotty, due to intermittent power outages for prolonged intervals.
Fifteen individuals served as sources of information during this project. It was challenging to validate the information received from these sources. Some sources appeared to be reliable based on their titles and socioeconomic standing, but they were not familiar with the local conditions. One standard error in key informant research is to choose informants based on their social and economic status or their fluency in an international language rather than on their knowledge of the local situation (Kumar, 1989). The French language constituted another impediment. Many articles in the French language needed an English translation and were not used.
The HIV/AIDS global pandemic generated too much data for easy analysis. Information obtained about Cameroon was mostly grey literature obtained through social media. Social media arguments were partial, and neither the government nor the secessionists wanted to take responsibility for the information contributed by them. There were, therefore, no objectively verifiable results, which is a weakness inherent in qualitative research methods (Choy, 2014).
Literature Review
Do FBOs in Cameroon follow best practices in the management of HIV/AIDS prevention?
Promising and Best Practice (PBP) can be defined as, “an experience, initiative or program that has proven its effectiveness and its contribution to the response to the HIV/AIDS epidemic, and that can serve as an example and inspiring model for others (program planners, managers, and implementers).” (AWARE HIV/AIDS, n.d., p.12). This is the definition that was adopted by AWARE-HIV/AIDS project. AWARE-HIV/AIDS is a regional project, sometimes referred to as a workshop that covered 18 African countries, which included sixteen countries in West Africa and two states in Central Africa, including Cameroon. Funded by USAID and applied by Family Health International (FHI) as an effort to promote PBP in the fight against STI and HIV/AIDS in this region. To be perceived as an EBP, the following elements should be outstanding and this program should be: “useful, relevant, effective, innovative, produce results within a reasonable time, efficient/cost-effective, ethically sound, and sustainable” (AWARE HIV/AIDS, n.d., p. 1).
Five technical areas and two policies were selected as PBP during the AWARE HIV/AIDS workshop in Dakar 2004. These technical areas and policies will be analyzed to see how effective its application has been in Cameroon. These policies are:
The engagement of religious authorities in the attempt to fight HIV/AIDS and,
A model law on HIV/AIDS.
Five technical areas in terms of designated best practices to be examined here are:
Behavior Change Communication (BCC),
Voluntary Counseling and Testing (VCT),
Sexually Transmitted Infections (STI),
Prevention of Mother-to-Child HIV Transmission (PMTCT)
Care and Treatment (C&T)
The author of this research will critically examine literature that deals with the ways of managing HIV in Cameroon following the PBP technical strategies and policies to come out with the role of FBOs in the process of managing the epidemic of HIV/AIDS in Cameroon.
Policy Change and Community Based Health Financing
Involve Religious Authorities (FBOs) to Fight against HIV/AIDS
FBOs exist in Cameroon and have been instrumental in HIV/AIDS cure and care. The work of FBOs in Cameroon presently cannot be overlooked. They operate health networks and are active partners in the national HIV/AIDS response in Cameroon (PEPFAR 2018). The Roman Catholic Church operates the most extensive health network, and the Cameroon Baptist Convention Health Services (CBCHS) works in collaboration with the United States Government (USG) to help prevent mother to child transmission (PMTCT). The Presbyterian and Seventh Day Adventists also have a vast network (PEPFAR 2018).
Professor Tih Pius, the director of the Cameroon Baptist Convention Health Services (CBCHS), also acknowledged that FBOs provide 30% to 70% of health care in most developing countries. (Tih, 2018). Some FBOs procure and distribute essential medicines to complement government systems, others do necessary testing, carry out preventive strategies, treat and cure, and fight against counterfeit and substandard drugs (Tih, 2018).
The Catholic relief services made its first appearance in Cameroon in 1961, adapting their program to the changing circumstances of the country and the needs of the Cameroon people. They initially worked to reduce the death rate of children under five, with a vision of improving food supply in the North of the country where there was drought-related hunger. Later, they moved to governance, health, and HIV programming. Currently, their focus is on supporting refugees, orphans, and vulnerable children and community health, including water and sanitation in Cameroon (CRS faith Action Results – Cameroon, n.d.).
CBCHS are at the forefront of the HIV/AIDS battle in Cameroon. The church started the medical branch in the 1930s but was only in 1975 that they became an FBO. CBCHS is an indigenous Cameroonian nonprofit organization with a mission to provide care to all individuals in need of it as a way of expressing Christian love. They address both clinical and public health problems affecting individuals and communities in Cameroon and Africa at large. They run five hospitals, 24 integrated health centers, and 50 primary health centers. In addition, the CBCHS works on the “prevention of mother to child transmission (PMTCT) and care and treatment (C&T)” while “CBCHS pharmaceutical produces and distributes a well comprehensive AIDS care and prevention program” (Bonje et al., 2012, p. 3). CBCHS’s services exist in seven out of ten regions in Cameroon, ranging from rural primary health care to highly specialized hospital-based care with an integration of other social services (Tih,2018). CBCHS partners with several national, international, governmental, and nongovernmental health-care organizations as well as with funding agencies throughout sub-Saharan Africa and globally. Therefore, CBCHS is a crucial partner to the government and is a leader in HIV/AIDS response in Cameroon.
The advocacy for FBOs to join the fight against HIV/AIDS is not new. The world council of churches advocated for churches to be transformed in the face of the HIV/AIDS crisis so that they may become a force for change and bring healing, hope, and comfort to all affected by HIV/AIDS. This is because churches have strengths and credibility, and they are grounded in communities. This connection with communities allows ministries to make a real difference in combating HIV/AIDS (Ibid). According to Kron (2012), the United States recognized the influence FBOs had over the prevention of HIV, and the state’s government revised its policy in 2003, teaming up with FBOs, and adopting the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) (Karon, 2012). Likewise, in 2014, CDC/PEPFAR funded the Local Capacity Initiative (LCI) project submitted by the CBCHB, which was tailored to respond to this project to scale up and improve the quality of HIV prevention of Mother-To-Child services in the Northwest and Southwest regions of Cameroon (CBCHB Free Projects, 2014). Similarly, Welty et al. (2005), prove that FBOs could be trusted and it is best practice to include them in the management of HIV/AIDS in Cameroon.
Model laws in HIV/AIDS
Africans infected with HIV/AIDS are usually deprived of their human rights. Children are usually denied education, and widows and orphans have difficulty when exercising their inheritance rights. Stigmatization and subsequent discrimination that are linked to HIV/AIDS push infected people into hiding. It was, therefore, essential to have an adequate legal framework to fight against HIV/AIDS-related stigmatization or discrimination (USAID, 2011). To address this, the leaders of eigteen West and Central African counties met in N’Djamena in September of 2004, to create a model law that was adopted by the participants with an objective to design “an action plan for the adaptation, adoption, and promotion of the Law” (USAID, 2011, p. 10). Benin’s Law 2005-31 came as a result of Leon Bio Bigous’ return from the 2004 N’Djamena workshop.
In Cameroon, no bill that addresses oppression and discrimination of people with HIV/AIDS has been adopted as such. However, Akonumbo (2006) identifies HIV/AIDS policies in Cameroon and legal considerations that help address this indirectly. The author gathers some of the significant challenges confronting or likely to face HIV/AIDS policies in the state. Cameroon depends on the international and regional legal framework for HIV/AIDS legislation. The primary Cameroonian texts governing HIV are those creating the institutions responsible for implementing HIV policies as well as those relating to specific cases, for instance, the anti-retroviral drugs (Akonumbo, 2006).
The sole legislation on HIV is the 2003 law regulating blood transfusion and a draft law targeting the rights and obligations of People living with HIV/AIDS (PLWHA). This notwithstanding, since “in the absence of specific HIV/AIDS legislation, the reading of relevant provisos in the revised Constitution of 1996, the Penal Code and case law, may help indicate the possible juristic approaches to HIV/AIDS in Cameroon” (Akonumbo, 2006 p. 92). These approach of model laws for HIV/AIDS as the best practice is criticized by many. In the research paper by Grace (2015), she said, “although best practice standardization has been a critical feature of global health institutions work activities in the HIV response over the past two decades, recent replications related to the criminalization of HIV transmission illustrate the potential public health dangers of ‘don’t reinvent the wheel’ thinking. I offer a normative critique of the transnational, text-mediated process that has produced highly problematic laws” (Grace, 2015, p. 441).
Five technical Strategies for HIV/AIDS (PBP) include the following: Behavior Change Communication (BCC), Voluntary Counseling and Testing (VCT), Sexually Transmitted Infections (STI), Prevention of Mother-to-Child HIV Transmission (PMTCT) and Care and Treatment (C&T)
Behavior Change Communication (BCC)
In the Communication for Behavioral Change in Sex Workers for the Prevention and Management of sexually transmitted infections (STI)/HIV/AIDS on Migratory Routes in Togo document, the authors state that “SISTER-TO-SISTER” project is a sexual BCC project selected as PBP which aims sex workers along the Lome – Cinkasse route. Also, “educators recruited from the target population of sex workers carry out social mobilization among their peers, in HIV/AIDS/STI prevention to change the perceptions of sex workers about the risks of infection, encourage proper and systematic use of male and female condoms for intercourse with clients or regular sexual partners, help their peers to have improved management of STIs, and easy access to voluntary counseling for HIV and to condoms at all sex work sites” (AWARE HIV/AIDS, 2011, para. 15). This project lasted four years under the supervision of the NGO FAMME funded by the Department for International Development United Kingdom (DFID). Literature reviews have always considered BCC as an essential step in social marketing on the prevention of HIV. Awasthi and Awasthi (2019) explain the various BCC movements that use mass media and have become useful in creating awareness and promoting a change for the better in one’s behavior for large populations over a short timeframe.
The BCC campaign carried out in Cameroon on HIV/AIDS was successful, as evidenced in the “100% Jeune” project campaign that was a social media campaign. This campaign in particular, “involved activities like peer education at multiple locations, a monthly magazine, information dissemination through an 18-episode drama, and call-in shows via the radio, television, billboards, and establishment of user-friendly condom outlets for users” (Awasthi & Awasthi, 2019, p. 80). Moreover, Meekers, Agha, and Klein (2005) concluded that for the BCC to affect the rates of condom use, the “100% Jeune” social marketing program should be repeated to be effective.
Voluntary Counseling and Testing (VCT)
The Strengthening Access to Voluntary Counseling and Testing for Young Students in Burkina Faso 2003 is the project that qualified the country as PBP on VCT, meaning that the example of Burkina Faso should be emulated by others. Every year, this initiative’s management organize a national HIV/AIDS voluntary testing campaign that can be done in schools and universities to enhance VCT in schools as well as to promote low-risk HIV/AIDS behaviors. This study was in line with several behavioral studies that also showed there are many cases of persistent risky behaviors in this area, infrequent condom uses, and sex between students and teachers in schools and university campuses despite the efforts to raise awareness about premature pregnancy and diseases risks. The active involvement of the Ministry of Education was the main contributor to this campaign (AWARE HIV/AIDS, 2011). Cameroon has not been highly successful in emulating the Burkina Faso VCT project. A literature review on VTC in Cameroon portrayed many reasons why VTC failed. Either the turnout of students was poor because it was costly as Haddison et al. (2012) note, or the students were not well sensitized and awareness and use of centers offering VCT for HIV were low (Ngwakongnwi & Quan, 2009). Lastly, the test results were not released the same day as the test (Ngangue et al., 2016).
Ngangue et al. (2016) identify factors that influence the quality of HIV counseling and testing services in district hospitals of the city of Douala, Cameroon. Findings range from inadequate infrastructure to ensuring the privacy and confidentiality of counseling, the client’s right to informed consent not being respected, and lack of prior consent. Counselors were not well trained, and test results were not given the same day as the tests (Ngangue et al. 2016).
Sexually Transmitted Infections (STIs)
Adapted Services for Sex Workers and their Sexual Partners: A Strategy to Reduce the Transmission and Minimize the Prevalence of HIV/AIDS is the project that made Benin a PBP. It “owes its efficiency to linking clinical care in adapted services with Behavior Change Communication (BCC), community outreach activities, consultation with security forces and sex work site owners, as well as regular follow-up activities” (AWARE HIV/AIDS, n.d., p. 34). These services included regular medical check-ups, fixed or advanced strategies for the active testing for STIs and their management, counseling, integrating the promotion of HIV voluntary testing and care targeting sex workers living with HIV, and prevention and care for other opportunistic infections. In Cameroon, STIs including HIV have been a central issue of public health challenges (Awuba & Macassa, 2007). Also, multi-country regional reviews conclude that despite prevention efforts, female sex workers (FSWs) remain one of the main populations affected by HIV/STIs, especially in Cameroon and Nigeria, two countries with the highest HIV and STI prevalence (Tukov, Jenevarius, & Ndzelen, 2016).
However, recent studies on STIs show that FSWs and men who have sex with men (MSM) carry high burdens of HIV, disproportionate to other populations. Still, they remain understudied and unsurveyed owing to legal, ethical, and social challenges (Bowring et al., 2019). MSMs have a higher probability of living with HIV than other adult men in low- and middle-income states. In Cameroon, they face barriers when accessing HIV services including a lack of specialized care and community-level stigma as well as discrimination (Holland et al., 2015). Therefore, policy development initiatives and programs to enhance sexual health knowledge and behavior among men would be helpful in reducing STI incidence in Cameroon. Currently, thousands of men in Yaounde have been convinced by sex workers to get tested in a project run by CARE International and local partners called Horizons Femmes (Lazareva, 2017).
Prevention of Mother-to-child HIV Transmission (PMTCT)
PMTCT was a Cameroonian project funded by EGPAF, implemented by CBCHB. CBCHB “began a PMTCT in 2 regions, intending to reduce the incidence of HIV infections in children by scaling up the PMTCT services in six of the ten regions of the country, covering at least 100,000 pregnant women by 2007” ( (“HIV Free project CBCHS,” 2019, p.44). The objective was to, “integrate PMTCT services into routine antenatal services in two regions by 2004; adopt a Community-Based Approach in Service Delivery (bottom-up approach); intensify training of trainers and raise the number of counselors from 21 in February 2000 to 500 by December 2005 and collaborate with the National AIDS Control Committee (NACC) in the training activities” (“HIV Free project CBCHS,” 2019, p.45). After 12 years, HIV seroprevalence decreased from an average of 10.3% in 2000 to 5.0% in 2011 among women tested in antenatal care and labor and delivery. A total of 40,265 women received ARV prophylaxis, as well as 21,345 infants (“End of project report – Cameroon,” 2012).
Globally, when implementation of PMTCT services prevented “around 1.4 million HIV infections among children between 2010 and 2018” (UNAIDS, 2018, p. 10). Despite the progress made through PMTCT, the pediatric HIV epidemic in Cameroon remains to be a major concern. Apart from this, policymakers need more information about the extent of the pediatric HIV epidemic (Nguefack et al., 2015). Nevertheless, authors of several reports point to the beneficial effect of male partner involvement in programs, which target the prevention of MTCT of HIV in reducing the number of pediatric HIV infections (Morfaw et al., 2013). Additionally, Fondoh and Mom (2017) report that the risks of MTCT when HIV-positive mothers were on cART were 2.49 times lower compared to women who were not on cART. Hence, maternal antiretroviral interventions should be addressed, and medical professionals should encourage HIV-positive pregnant women to use a combination of ART (cART).
Care and Treatment (C&T)
The Care for People Living with HIV through the Medical and Social Support Center is the project in Côte d’Ivoire AWARE participants admire as a PBE for providing care and treatment. The establishers of the Medical and Social Support Center (Centre d’Assistance SocioMédicale/CASM) created it to help decongest health facilities, at least partially, and aid in providing compassionate care to PLWHA. This facility serves as a bridge between PLWHA, their families, and their communities. This project was funded by HOPE Worldwide Côte d’Ivoire, an agency of HOPE Worldwide, an American faith-based nongovernmental organization, and this project benefits PLWHA and their families, regardless of their race, nationality, or religion.
In Cameroon, the Ministry of Social Affairs, other development partners, and the Ministry of Public Health try to provide care for HIV/AIDS orphans and vulnerable children (OVC). They provide psychosocial support, such as counseling to OVC and families, caregivers, as well as provide education and training, medical care, and income-generating activities. Integrated Foundation Development (IFD) and many partner NGOs are advocating for the training initiatives to empower the OVC population to fight for their rights.
IFD provides material support to OVC for necessities, for example, clothing, shoes, food, and other items. (Integrated Foundation Development, 2019). The practice of community care for the OVC population is widespread, for instance, the government, in partnership with the Global Fund, bilateral and multilateral organizations, and NGOs, support local communities in an effort to improve their capacity to care for OVC, including the creation of income-generating activities, which is the basis of community ownership and sustainability. The integrated care of the OVC population is possible in Cameroon. Unlike in Ivory Coast, in Cameroon, the Cameroonian government leads a continuous multi-sectional approach to solve the issue of OVC (Nsagha et al., 2012).
Argument: Using evidence-based practices, FBOs are the most effective institution for promoting preventive behaviors for HIV/AIDs in Cameroon:
The FBO’s involvement in the African HIV/AIDS epidemic is the best method, an initiative that has proven its efficiency and its potential to contribute to the response to the HIV/AIDS epidemic. The incorporation of the evidence-based practices (EBPs) into FBOs’ service programs enhances their effectiveness (Terry et al., 2015). In this paper, the author argues that FBOs are the most effective institutions for promoting preventive behaviors for HIV/AIDS in Cameroon. This argument is valid because many governmental and nongovernmental organizations (NGOs) do not uphold the moral standards when managing governmental and charitable institutions, mainly due to poor governance and corruption (O’Donnell, 2018). In his doctoral dissertation, Lewis (2019) acknowledges that “government corruption in developing countries metastasizes like cancer, slowly capturing and then deteriorating the ability of government institutions to fulfill their promised duties”(p. ii). Similarly, according to the popular representations of politicians in Africa, a typical African head of state is corrupt, dictatorial, selfish, and problematically conservative (Essoh, 2020).
FBOs have made great progress in managing HIV/AIDS spread globally, especially in the domain of prevention. The combination of prevention and the prayer doctrine acts as an enabler for compliance with the best practices and recommendations. The success of FBOs, a subset of NGOs, was recognized as valuable by President Clinton’s charitable initiatives in 1996 and President Bush’s initiatives in 2001 for FBOs, making FBOs a platform for sponsors (Hong, 2012). These evaluators have given FBOs a better grade than any other organization. An analysis of best practices of 52 studies reveals that use of faith, appropriate staffing, humanized leadership, and proper funding were the four critical factors that led to the best macro practices in FBOs (Hong, 2012). FBOs are significant providers of healthcare and support services to people, who live with HIV/AIDS around the world, and they spread education and prevention messages to the most remote villages.
The HIV/AIDS epidemic is still a global concern, and there is the need to target Cameroon because it was the hardest-hit region in West and Central Africa in 2004 and still has a relatively high incidence rate (UNAIDS/WHO 2004; Plan, 2019). Despite all attempts to mitigate HIV/AIDS, Cameroon is one of the least successful countries when evaluating the progress towards the UNAIDS 90-90-90 targets in Population-based HIV Impact Assessment PHIA (“PEPFAR progress reports,” 2018).
iii) The problem Cameroon is facing is not the lack of financial assistance, education, and counseling, or medication to treat its people, although the main problem is the governance of these resources. Two characteristics of good governance that set FBOs apart from most secular humanitarian organizations are their faith, which is a powerful motivation for humanitarian action, and their constituency, which is broad, and centers around the poor and the marginalized (Ferris, 2005).
Supporting arguments/claims
Political/Economic
FBOs instill greater trust and demonstrate less evidence of corruption in health interventions when compared to the Cameroonian government
Corruption. Corruption is a difficult concept to define because people look at it from varied perspectives (Nduku, 2015). One way of characterizing corruption is as mismanagement, lack of accountability, lack of transparency, bribery, embezzlement, injustice, immorality, the abuse of power, the colonization of social relations, conduct or practice in flagrant violation of existing rules and procedures, and as an evil that has challenged many societies in the world.
Corruption is a pressing issue in Cameroon, where the absence of good governance and the country’s abject poverty are huge obstacles to development (O’Donnell, 2018). The mismanagement of funds and the lack of accountability are significant setbacks to the progress of HIV prevention and treatment (Akonumbo, 2006).
Cameroon, in 1998 and 1999, was the most corrupt country in the world, according to the Corruption Perception Index (CPI) (Stückelberger, 2003). The 1998 CPI was a wake-up call to the Cameroon head of state to confront the country’s pervasive corruption. The CPI ranking led to the development of the first code of conduct to combat corruption and promote transparency in NGOs and churches in Africa, funded by the Bread for All initiative from Switzerland. The Anti-Corruption Clause for Contracts states that “the contractual parties shall neither offer a third person nor seek, accept or get promised directly or indirectly for themselves or for another party any gift or benefit which would or could be construed as an illegal or corrupt practice” (Stückelberger, 2003 p. 20). This code raised anti-corruption awareness among staff and board members of companies. It has also led to the brainstorming of new ideas for anti-corruption solutions and improved institutional structures such as separation of powers and controls, and many countries in Africa began to fight corruption.
The Catholic Bishops of Cameroon strongly condemned corruption in different sectors of the country’s governance in 1998. The 37th synod of the presbyterian church in Cameroon (PCC) accepted the government’s concern to combat corruption but urged the government to appoint people with proven moral integrity from the church to head the project and to sanction those who mismanaged public funds. The Cameroon Federation of Protestant Churches and Missions (FEMEC) published a booklet entitled “Jugulate Corruption” (FEMEC, 2000). A FEMEC youth forum created its own Code of Conduct on Corruption in August 2002.
In 2005, Cameroon showed a slight improvement by ranking137 out of 158 counties in CPI. This persistent mediocrity motivated the head of state to discreetly sack some officials of the National AIDS Control Council (NACC) for misappropriation of HIV/AIDS funds. In 2006, Cameroon showed slight improvement, ranking as 138 out of 163 countries surveyed (Akonumbo, 2006). That same year, ministers and former directors of state-owned corporations were arrested for fraud and misappropriation. Corruption is still rampant in Cameroon despite the government’s anti-corruption measures. If left unaddressed, corrupt practices and embezzlement of funds will not allow any meaningful HIV/AIDS mitigation initiative to succeed.
FBOs do actually play an important role in combating corruption and promoting justice (Nduku, 2015). They can be effective anti-corruption tools if they are allowed to work on their own terms. A research study conducted to find out if the level of religiosity in an institutional environment can affect the emergence of the corporate governance system in Nigeria revealed that religion had not stimulated the desired corporate governance because of prioritizing orders from the government over religious practices (Nakpodia et al., 2020). Though some empirical studies have suggested that African countries, similar to Cameroon, which have strong hierarchical religions, for example, Islam, Catholicism, or Orthodox Christianity, are more inclined to suffer from corruption, there is still no strong evidence in support for this correlation (Ko et al., 2014). However, FBOs foster religious ethics and advocate for human rights principles, and fighting corruption is part of these religious principles (Browne, 2014). Therefore, FBOs must be part of the anti-corruption efforts to free the exploited and marginalized people from the chains of poverty (Nduku, 2015). Currently, the involvement of Churches, other FBOs, development agencies, and mission networks show signs of progress in the anti-corruption domain.
User Fees Mismanagement
CBCHB is the FBO that cares for 97% of all patients on treatment in PEPFAR’s program, 94% of all new patients placed on treatment in FY18, and 97% of all viral load tests performed in Cameroon (Birx, 2019). They still collect user fees for HIV prevention and treatment. There is, therefore, a significant legal barrier that can only be resolved with a new government policy in place that allows the FBOs to work on their terms.
Evidence shows that removing user fees could improve service coverage and access, but this must be a well-calculated event because acting without prior preparation could lead to unintended effects, including compromising quality and excessive demand on health workers (McPake et al., 2011). Boyer et al. (2009) produced a typical expenditure statement of an HIV patient in Yaoundé, the capital of Cameroon, which reads:
“The median monthly direct out-of-pocket health expenditure of ART-treated patients was 9800 FCFA (IQR: 6300–18 600), or 20 US$ (IQR: 13–38). Of this amount, 3000 FCFA (IQR: 3000–7000), or 6 US$ (IQR: 6–14), went mainly to the purchase of ART; 1000 FCFA (IQR: 600–2,000), or 2 US$ (IQR: 1–4), went to transportation costs to the hospitals, and 1600 FCFA (IQR: 0–3,000), or 3 US$ (IQR: 0–6), went to healthcare professionals’ consulting fees. These amounts comprised 47.0%, 12.0%, and 6.0% of the total expenditure, respectively. Other expenditures went to medication other than ART, biological tests, hospitalization, and traditional medicine” (p. 4).
This article envisaged that “free-of-charge ART at the point of delivery,” as endorsed by the WHO, is one of the critical components for reaching “the goal of universal access to HIV/AIDS care and treatment by 2030” (Boyer et al., 2009, p. 4). Similarly, literature reviews on empirical evidence gathered since the 1980s clearly show that sustainability, efficiency, and equity problems faced by public health care systems in developing countries persist due to the introduction of user fees (James et al., 2005). There are reports, however, that free HIV outreach programs have expanded the utilization of prevention and care despite that the HIV/AIDS stigma remains burdensome (Desclaux et al., 2007; Eboko et al., 2010).
The financial burden of user fees leads to late diagnosis, late treatment, and an increased number of new infections. Luma et al. (2018) also confirm that the late start of HIV care is remarkably high at the Douala General Hospital (DGH), and it is associated with poor outcomes. According to a briefing to the U.S. Ambassador to Cameroon, Peter H. Barlerin, delivered by Ambassador Deborah Birx, it was reported that formal and informal patient fees remain commonplace in clinics in Cameroon. The Cameroon government does not have the resources to effectively treat patients who need constant life-saving treatments (Birx, 2019). Moreover, user fees have led to a drastic drop in patient retention from 79% in 2017 to 32% in 2018. While acknowledging the financial barriers imposed by user fees in an emergency context, there is consensus that essential health services during a humanitarian crisis should be provided free of charge at the point of delivery (Boyer et al., 2009). The preliminary progress that was made during the initial stages of a voucher program allowing to pay for the costs of these fees is much appreciated. However, this is not a long-term solution to eliminating user fees (Bix, 2019).
Consequently, on 4 April 2019, the Cameroon Minister of Health ordered the elimination of all HIV service fees in healthcare facilities. This is not the first time the Cameroon government has issued such legislation. The financial consequences of this decision were included in the 2020 Cameroon budget, and the funding for PEPFAR for COP 2019 and COP 2020 relied on the effective implementation of the abolition of user fees government-wide and on-site (Birx, 2019). If this new budget is professionally managed, CBCHB will stop collecting user fees, thereby improving HIV/AIDS prevention and care in Cameroon.
Data-Driven
There is evidence supporting the need to include FBOs in the strategy of combating HIV/AIDS as first-hand support.
FBOs Fight against HIV/AIDS in Cameroon
Cameroon FBOs have been instrumental in HIV/AIDS treatment and care. They run health networks and are active partners in the national HIV/AIDS response in Cameroon (PEPFAR 2018). The Roman Catholic Church runs the most extensive health network, and the CBCHS works in collaboration with the USG to help prevent MTCT. The Presbyterian and Seventh Day Adventists also have a considerable network (PEPFAR, 2018).
Professor Tih Pius, the Director of the CBCHS, also acknowledged that FBOs provide from 30% to 70% health care services in most developing countries (Tih, 2018). Some FBOs procure and distribute essential medicines to complement government systems, others do necessary testing, carry out preventive strategies, treat and cure, or fight against counterfeit and substandard drugs.
The Catholic relief services made its first appearance in Cameroon in 1961, adapting their program to the changing circumstances of the country and the needs of the Cameroon people. They initially worked to reduce the death rate of children under five, with a vision of upgrading food supply in the northern regions of the country, where there was drought-related hunger. Later, the relief services changed their strategy and worked on governance, health, and HIV programs. Currently, their focus is on supporting refugees, orphans, and vulnerable children and community health, including water and sanitation initiatives in Cameroon (“CRS faith Action Results – Cameroon,” n.d.).
CBCHS are at the front of the HIV/AIDS battle in Cameroon. The church started the medical branch in the 1930s but only in 1975, they became an FBO. CBCHS is an indigenous Cameroonian nonprofit organization, which declares a mission to provide care to all people, as a manifestation of Christian love. They address both clinical and public health problems affecting individuals and communities in Cameroon and Africa at large. They run five hospitals, 24 integrated health centers, and 50 primary health centers, “besides, with 13 components, including Prevention of mother to child transmission (PMTCT) and care and treatment (C&T), CBCHS pharmaceutical produces and distributes a well comprehensive AIDS care and prevention program” (Bonje et al., 2012, p.3). CBCHS’s services exist in seven out of ten regions in Cameroon, ranging from rural primary health care to highly specialized hospital-based care with an integration of other social services (Tih, 2018). CBCHS partner with national and international governmental and nongovernmental healthcare organizations and funding agencies throughout sub-Saharan Africa and globally. They form a crucial partner to the government and are the technical leaders in the HIV/AIDS response in Cameroon (Tih, 2018).
Considering the influence FBOs have on the prevention of HIV, CBCHB revised its policy in 2003, teaming up with FBOs, and adopted the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) (Kron, 2012). Likewise, in 2014, CDC/PEPFAR funded the Local Capacity Initiative (LCI) project submitted by the CBCHB, which was tailored to respond to the epidemic and scale up and improve the quality of HIV prevention of Mother-To-Child services in the Northwest and Southwest regions of Cameroon (CBCHB Free Projects, 2014). Similarly, Welty et al. (2005) proved that FBOs could be trusted, and it is best practice to include them in the day-to-day management of HIV/AIDS in Cameroon.
There is evidence of previous successful promotion of preventive practices for HIV/AIDs:
Baptist and PMTCT
Not many peer-reviewed articles exist on FBOs in Cameroon. There is, however, grey literature on the role of FBO in HIV care and prevention in Cameroon. For example, an article by Pius Tih Muffih, the DirectorDirector of the Cameroon Baptist Convention Health Services (CBCHS). CBCHS is a comprehensive health agency that is currently transforming HIV prevention in sub-Saharan Africa. The Government of Cameroon’s main HIV response collaborator and strategic pioneer in the reduction of PMTCT (Tih, 2018). Welt et al. (2005) have proven that FBOs could be trusted, and it is best practice to include them in the process of management for HIV/AIDS projects in the state. In this article, the authors describe a CBCSH project funded by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF). The aim was to implement a program in PMTCT, which was successful (Welty et al., 2005). After 12 years, HIV seroprevalence decreased from an average of 10.3% in 2000 to 5.0% in 2011 among women tested in antenatal care and labor and delivery (Bonje, Khan, & Miller, 2012).
Museveni, Uganda, ABC
Other African countries have used FBOs in the successful management of HIV/AIDS. For instance, Uganda is one of the world’s first and most convincing national success stories in the domain of combating the spread of HIV (UNAIDS, 2004). Uganda’s early success in battling HIV included behavioral change campaigns aimed at decreasing the number of sexual partners among Ugandans. The president of Uganda used religious organizations to transmit the ABC slogan of HIV/AIDS behavioral change messages, which stands for Abstinence, Be faithful, and or use Condom if A&B fails, which t led to the success of HIV/AIDS prevention in Uganda (Green, 2001). In a way, the President of Uganda started a war against HIV/AIDS through communication via FBOs and social media. To the question of whether FBOs’ involvement was the game-changer, Green (2001) answered affirmatively by elaborating:
“There is some evidence from impact studies, such as those of a UNAIDS “Best Practices” project of the Islamic Medical Association of Uganda (IMAU) study (Kagimu, Marum, Wabwire-Mangen, et al. 1998), that AIDS prevention activities carried out through religious leaders have had a significant direct effect on, particularly targeted populations. It does appear that in situations in which religious organizations put emphasis (sometimes sole emphasis) on behavior change, in the form of abstinence and fidelity, the behaviors changed dramatically” (p. 10).
Unfortunately, today, the prevalence of HIV among adults aged 15 to 64 in Uganda is 6.2%, 7.6% among females, and 4.7% among males. It corresponds to approximately 1.2 million individuals aged from 15 to 64, who are living with HIV in Uganda (MoH, 2017). The author passionately believes that preaching prevention with the use of FBOs is not enough to make a difference. The results will be significant and sustainable if backed with the implementation of evidence-based practices on HIV/AIDS prevention because education alone is a weak, low-value improvement intervention. Education is often necessary but rarely sufficient without additional measures (Soong & Shojania, 2020). Here, the following limitations of education are highlighted:
Education relies heavily on human memory and vigilance and does not guarantee that the new information will be correctly applied in the right circumstances and will lead to the desired behaviors.
Education will not solve memory slips or lapses nor easily change habits or at-risk behaviors.
Education does little to change system reliability.
Education requires frequent repetition.
Educating practitioners talking about desired behaviors might not be enough if there is external pressure to behave differently.
Beer et al. (2016) refer to healthcare’s reliance on education as the “great training robbery,” noting that systems spend large amounts of money and time on employee education without a good return on their investment. (p. 50). With all these solid reasons, it was wise to back up FBO preaching and education with some practical and evidence-based strategies.
Cameroonians prefer relying on FBOs in health-related matters when cures and treatment are scarce or non-existent. “Go back to God.”
AIDS has no cure, the only weapon one has is to rely on the prevention of the acquisition of new infections. Some notable factors from the HIV success stories are that behaviors have fundamentally changed when simple messages of abstinence, faithfulness, and use of condoms are communicated. Green et al. (2016), for example, are convinced that “these successful responses have often been community-based, low cost, low tech, and culturally grounded. Rather than relying on foreign technology, products, or expertise, they have been built on the knowledge, institutions, and cultures of affected communities” (p. 12). Religion or more specifically, faith-based organizations, influence the socio-cultural environment that decrease the risk of infection and allow to offer preventative interventions to the broader community. The world Council of Churches advocated for churches to be transformed in the face of the HIV/AIDS crisis so that they may become a force for the transformation and bring hope with healing and comfort to all affected by HIV/AIDS. The importance of religion-based organizations in the fight against HIV/AIDS has now become famous because churches have demonstrated time and again that their credibility, influence, and strength in the community can impact change in the behavior of people in that community (Ochillo et al., 2017).
Koenig (2009), a well-known researcher on religion, spirituality, and health, defines religion as the practices and rituals related to the sacred. These practices and rituals refer to Islam, Christianity, and indigenous beliefs, the primary forms of religion existing in Cameroon. (Schilder, 1988). Cameroon is a religiously tolerant country because the constitution allows freedom of conscience and religious worship. Christians form the bulk of the population, followed by Muslims and the indigenous believers (Schilder, 1988).
Based on the author’s childhood experience, religion is regarded with remarkably high esteem and is considered the most potent driving force in a typical Cameroonian family. When the resources are available, most Cameroonians will choose mission hospitals over government hospitals, mission schools over government schools. It is, however, regrettable that not many peer-reviewed articles exist on religion and HIV/AIDS in Cameroon, considering its importance for an average Cameroonian family. It is not strange because FBOs have historically played an essential role in delivering health and social services in developing countries, with extraordinarily little research on their role in HIV?AIDS prevention and care (Derose et al., 2010). The absence of recognition of the influence of religious organizations in the fight against AIDS is, however, not very strange because Gardner (2000) had called this doctrine a “virtual foreigner in the literature of AIDS since the year 2000” (p. 41).
In the same light, Jill Oliver (2000), in his article on the Religious and HIV/AIDS Policy, noted the “invisibility of religious organizations to the view of public health and policymakers” (p. 82). He further notes that it was only in the late 1990s religious organizations became partners in the fighting against HIV/AIDS in the African continent. Since then, religious organizations, as well as international NGO, such as UNICEF, WHO, and the Bill and Melinda Gates Foundations, developed an interest in sponsoring research on faith-based organizations in health matters (Olivier, 2011).
It is, therefore, imperative to emphasize the preventive aspect of the fight against HIV, which will probably help reduce the number of new infections. FBOs play a role in both prevention and treatment. One crucial role that they seem uniquely qualified to undertake is that of prevention, reducing the stigma associated with HIV in the faith community and the broader population. The Bishops of Cameroon had earlier echoed similar views when they called on the church to wage war against this pandemic, through sensitization, information, and educational activities, without hesitating to fall back on their cultural and spiritual values (NECC, 1999). Thus, Cameroon’s traditional religion and HIV/AIDS go hand in hand.
Capacity for care
FBOs are “hands-on” and follow-up closely with patients monitoring for their biophysical, spiritual, and social well-being while the government is mostly focused on the treatment aspect.
Faith-based organizations have proven their importance in the fight against AIDS, and they uniquely stand out because they are embedded in their local communities and have a global reach. Their large constituencies give them the advantage to play a vital role in advocacy and public awareness. Their presence on the ground permits them to go to places where government campaigns cannot reach. They are, therefore, well-positioned to act when emergencies arise (Ferris, 2005). FBOs are, in many cases,, the only genuine non-for-profit organizations in many rural parts of Cameroon. They always have a good comprehension of local social and cultural patterns, and larger ones may have reliable infrastructures. Many FBOs have experience working in healthcare and education domains, and there are many faith-based hospitals and schools in Cameroon. FBOs have the power to mobilize a substantial number of volunteers. They can be influential in policy debates concerning the legal, ethical, and moral issues surrounding AIDS and human rights (Lazzarini, 1998)
Limits to FBO Work in HIV/AIDs
Problems with the ABC method
FBOs emphasize the virtues of abstinence and faithfulness as the sole approach to prevention, which is why they face continuous opposition from other stakeholders who believe the promotion of condom use is more effective (Tiendrebeogo, 2004). However, FBOs strongly believe that promoting condoms will encourage sex outside of one’s marriage and promiscuity. They want to improve awareness of HIV-related knowledge, delay individual’s sexual debut, and decrease extra- and pre-marital sex (Tiendrebeogo 2004). On the other hand, prohibiting condom use will potentially reduce “knowledge, skills, and the willingness of members to use condoms during risky sexual behaviors, putting the lives of women at risk” (Murphy et al., 2006, p. 4).
Today, Uganda stands as a global reference point for its reported success in reducing the levels of HIV-1 infection from 30% in the mid-1990s to 10% within a decade (Green, 2003; UNAIDS, 2000). This success has become an international template for effective HIV/AIDS intervention, particularly in developing countries (Allen, 2006). Despite Uganda’s success, many controversies exist over this claim. One issue is that there is no convincing evidence that the country ever had a 30% prevalence rate (Allen, 2006). This is because, before 1995, demographic and health data was both limited and fragmented. Secondly, the first generation of HIV prevalence data can hardly be relied upon to supply a detailed representation of the number of infected persons.
The ABC model has become synonymous with a proper HIV/AIDS intervention (Slutkin et al., 2006). This attribution of success dedicated to the ABC model has influenced recommendations for international policies as well as funding and aid allocation decisions (Cohen, 2005). This evidence is highly contested, for example, Wawer et al. (1997) found emigration and mortality to be the most puzzling variables related to the observed decline in prevalence rates. Indeed, several studies commissioned by the United States government between 2002 and 2004 concluded that increased rates of abstinence and fidelity were the reason for the reported decline in HIV prevalence in Uganda in the 1990s (Green, 2003) Macintyre et al. 2001) found the personal experience of AIDS to be the most noticeable predictor of behavior change in working and married men aged 24-40.
The policy of openness, political will, and commitment are the key elements that led to increased awareness and understanding among the population. For example, awareness led to a reduction in HIV/AIDS prevalence and incidence (UAC, 2003). The government of Uganda itself has recognized the role played by NGOs, people living with HIV/AIDS (PLWHA), and community-based organizations (CBOs). Such recognition means that any success achieved in the struggle against HIV can hardly be attributed to a single factor or player. Therefore, learning the ABCs is not the only solution and more policy changes and practices should be implemented. It should be an ongoing process of governments and all other stakeholders working collaboratively to scale up quality, using evidence-based approaches that “fit” the national epidemic, followed by continuous monitoring and evaluating outcomes and strategizing (Collins, 2008, p. 9).
Other problems
FBOs’ attitudes and beliefs are judgmental towards people that are in same-sex relationships. Next, FBOs encounter organizational barriers because there is no structure that brings together all faith groups, and sometimes, disagreements and tensions between different FBOs and secular health organizations may limit the actions of FBOs. Collaboration with other organizations is needed for FBOs to operate to their maximum ability. They should complement the activities of others, reinforce the activities undertaken by others, ease the activities of these institutions, and support the activities undertaken by them (Derose et al., 2010). Moreover, leaders in the public health sector should creatively explore whether FBOs’ resources and skills can be successfully used to meet the urgent needs raised by the outbreak of HIV.
Discussion
The HIV/AIDS epidemic is still a global concern and there is the need to target Cameroon since it used to be the hardest hit region in 2004 with HIV prevalence rate estimated at 5.1%, the highest rate for the West and Central Africa sub-region. FBOs can influence socio-cultural factors that either increase or decrease the risk of HIV; and allow for preventative interventions to the whole community. Not many peer-reviewed articles exist on religion and HIV/AIDS in Cameroon considering the importance of these religious institutions for an average Cameroonian family hence grey literature comes in handy.
Potentially, FBOs are important players in HIV prevention and need more resources to support health promotion strategies. CBCHS is a robust health care organization now impacting HIV care and treatment in sub-Saharan Africa. It is also a key partner to the government of Cameroon in the HIV response and a technical leader in PMTCT.
Considering the role of FBOs in the management of HIV/AIDS prevention in Cameroon, and best practices in West and Central Africa that have had a significant impact in the fight against HIV is important because education alone is a weak, low-value improvement intervention: often necessary but rarely sufficient. Cameroon and Cote d’Ivoire are the least successful in terms of progress towards the UNAIDS 90-90-90 targets in PHIA states because management and accountability is a major setback. This is another reason why FBOs should play a core role in addressing the HIV/AIDS epidemic in Cameroon because they are more accountable and less corrupt.
Thus, the answer to the question, do FBOs in Cameroon follow best practices in the management of HIV/AItDS prevention? is: yes, they do. There is evidence supporting the necessity of including FBOs in the fight of HIV/AIDS. Model laws in HIV/AIDS may be in place to protect the essential rights of the women and the underprivileged. FBOs use BCC as an essential step in social marketing and VTC. STIs including HIV have always been the issues at the forefront of public health challenges. However, the most recent studies on STIs show that FSWs and MSM carry disproportionately high burdens of HIV. Still, they remain understudied and underserved owing to legal, ethical, and social challenges.
PMTCT is the brainchild of CBCHS, which has shown significant success in Cameroon and in Africa in general. Despite progress made in PMTCT, the pediatric HIV epidemic remains worrying in Cameroon. Nevertheless, many reports point to the beneficial effect of male partner involvement in programs for the MTCT of HIV in curbing pediatric HIV infections care and Treatment. Provided that FBOs can care for people, who live with HIV through a Medical Social Assistance Center, which is managed by the Ministry of Social Affairs, other development partners, and the Ministry of Public Health, FBOs’ use of PBP in fighting against HIV prevention in Cameroon can be a success.
Conclusion
The African Catholic Church through the voice of its Synod of Bishops advances the view that AIDS “is not to be looked at as either a medical pharmaceutical problem or solely as an issue of a change in human behavior. It is really an issue of integral development and justice, which requires a comprehensive approach and response” (as cited in Kelly, 2010, p. 251). The role of FBOs in HIV/AIDS prevention is extremely important but without internal development and justice, no amount of communication, education, ART treatments, or practices will do the job. The treatment must be holistic. Medical infrastructures must be developed, corruption must be abolished, and the rights of the underprivileged must be restored.
In this paper, I reviewed some of the commonly used practices for addressing HIV, such as the ABC method. The premise of raising awareness about this method is that by using the ABC, one can lead a life and engage in behaviors that will not subject them to exposure to HIV/AIDS. Although the Cameroonian government, the NGOs, and other states, including the United States understand the issue of the high prevalence of HIV/AIDS in Cameroon, there are several barriers to successfully fighting against the spread of this virus. The main issue is corruption and lack of accountability of the governmental organizations. Another issue is that FBOs typically condone the behavior of MSM and people who have relationships with the same sex.
In addition, the examples of Uganda as an African state that successfully reduced the number of HIV/AIDS infection cases from 30% of the population to 10% of the population is reviewed. Although some researchers question the validity of data, mainly the assessment methods used to estimate that 30% of Ugandans were infected with HIV in 1995, the country is perceived to be an example of a best practice and its experience is a template for other states in the region. Hence, the policies proposed in this paper can help curb the HIV/AIDS epidemic in Cameroon.
This review of the literature and the findings suggest that FBOs are suitable for implementing interventions that would target the HIV/AIDS issue in Cameroon, which is consistent with my experience. CLC type of paper is more suitable for this project since I have experience of living in Cameroon and I would like to help address issues, such as this epidemic with my future work. When living in Cameroon, I understood that FBOs play an important social role for the citizens. In terms of my Learning and Development Plan (LDP), this paper suggests that I should dedicate more attention to exploring the state-wide policies and health care interventions.
Reflection on Sustainable Development
At the 1992 United Nations (UN) Earth Summit in Rio de Janeiro, sustainable development was named one of the most urgent subjects for international policy. UN Agenda 21 was endorsed, proposing as part of its policy agenda a sustainable development plan based on the satisfaction of basic needs in developing countries. The Brundtland Commission defined the notion of sustainable development as the development that satisfies the needs of the present without having to compromise the needs of the future. There are some of the agreements that allow increasing the accountability of organizations in Cameroon as part of the development strategy below. Kate Raworth in her book titled Doughnut Economics put all humanity’s 21st-century challenge in a doughnut, and these are:
To meet the needs of all within the means of the planet.
To ensure that no one falls short on life’s essentials (from food and housing to healthcare and political voice), while ensuring that collectively we do not overshoot our pressure on Earth’s life-supporting systems, on which we fundamentally depend.
Achieving sustainable development involves an economic, social, and quality environment enhanced by good governance to secure effective citizen participation in decision-making.
The sustainable development agenda for 2030 has a health issue at its center. One of the goals of this agenda is to ensure healthy lives of people and promote well-being for all citizens of all ages. HIV/AIDS is one of the elements that stand to hinder the achievement of these goals. It remains one of the challenges facing Africa and it is far more than a health issue. It is a general crisis impeding development by imposing a steady decline in the key indicators of human development and hence reversing the social and economic gains that African countries are striving to attain. Moreover, this is a question of poverty and underdevelopment, and it constitutes a challenge to human security and human development by diminishing the chances of alleviating poverty and hunger, achieving universal primary education, gender equality, reducing child and maternal mortality, and enabling environmental sustainability. For me to live the doughnut life, good life, “buen vivire”, I must ensure that my neighbors are safe. I must communicate, educate, advise, preach to the world the consequences and impact of HIV/AIDS.
2002 to the Code from Cameroon
Meeting during a follow-up workshop in Yaoundé on 25 and 26 October 2002, the signatory organizations to the Code adopted the following annex, which is an integral part of the said Code.
Annex 1:
Ensuring transparency in elections within signatory organizations.
Transparency in elections is one of the guarantees of transparency within organizations. The signatory organizations undertake to strive for transparency at all stages of the electoral process, notably through the following measures:
Publication, within reasonable timeframes, of the list of posts to fill, description of tasks and profile of posts.
Definition and pre-dissemination of rules governing elections.
Putting in place of a mechanism to facilitate the registration of candidates and voters.
Selection of a neutral committee to organize elections.
Thesaid committee, comprised of people with established renown and integrity, could resort to expertise from people outside the organization.
Public and solemn proclamation of election results, followed by a reminder on the duties and responsibilities of newly elected persons.
How to ensure protection for those who deplore acts of corruption within our organizations?
Employees can be coaxed into becoming accomplices of corrupt practices, or be constrained from taking part in such practices by their bosses.
Employees can be made to take note of acts of corruption and to denounce them or ask thought-provoking questions relating thereto.
In both cases, the employee is exposed to physical, mystical, and psychological threats and can lose his or her job.
One can distinguish two cases:
Corruption at the helm of the organization, there is the will to effect change.
The organization is entirely corrupt.
Signatory organizations have undertaken to adopt the following solutions, which are likely to ensure better protection for those who denounce corrupt practices:
Adopt a code of procedures that expressly proscribes or prohibits acts of corruption and obliges every employee to denounce such acts.
Make provision in all contracts, for a clause that will oblige all employees to denounce acts of corruption, failing which could make them the subjects to being laid off. The courts could possibly apply such protection.
Recall that those who denounce corruption should base their claim on objectively verifiable facts. There are other measures which could be applied, but which have their limits.
Encourage frequent meetings of team members, during which possible cases of corruption could be brought up. Such meetings, nevertheless, can be the framework within which “noise makers” (those with unjustified evidence of corruption) could be discovered.
Encourage individual encounters between staff members and members of the Board of Directors. Hence, there is the risk that members of the Board of Directors could connive with Management if the latter is corrupt.
How to ensure the independence of the audit team?
Many cases in point can likely lead to an audit that is not independent or is of poor quality:
Bad faith or incompetence of the auditor.
The non-existence or non-respect of rules and procedures aimed at ensuring the objectivity of the auditor’s choice.
The auditor’s dependence vis-à-vis the organization, which ensures a long- term contract for him as well as a direct and encouraging remuneration.
The selection of the auditor by the Director of the organization alone.
The adoption of the following measures is likely going to strengthen the independence of the auditor:
Outline and publish procedures for selecting and dismissing auditors.
As best as possible, select an audit firm that has a reputation to preserve.
Establish a list of pre-selected candidates for auditing, to be submitted to funding bodies which will then proceed to the final selection.
Prohibit audit contracts on trial basis.
Lay down rules governing auditing within the organization.
Make a yearly assessment of the respect of procedures governing the selection and the functioning of the auditor, in a bid to carry out necessary rectifications.
Can the guiding code be respected without endangering the life of the organization, that is to say, can we function without being subject to corruption from without?
Organizations that are signatories to the code desire to curb corruption, but they operate in an environment wherein corruption for the most part continues to be the order of the day.
How can an organization exist – in carrying out its activities, in its relationships with other social actors – without participating in acts of corruption?
There are three possible situations:
Those who wield power can oblige us to give them money in order to carry out our activities.
To secure a public contract, it is generally indispensable to “agree” with decision-makers.
The tax scheme can be exaggeratedly unfavorable, to bring pressure to bear on organizations and oblige them to “agree” with civil servants who decide on such matters.
It is challenging to find a unique solution to this problem. Signatory organizations undertake to find solutions by gaining inspiration from the following proposals:
It is not forbidden to give gifts to the authorities in question, in respect of the African tradition. Such gifts must however, be limited in their worth and nature.
Organizations must improve the knowledge of their rights and execute their duties within stipulated time frames. A5) Youths Code of Conduct against Corruption, Cameroon 2002
We, the participants at the first FEMEC Youth Forum, holding in Buea, at the B.H.S. Campus, from 4th to 8th of August 2002, have this as a code of conduct to stamp-out Corruption for a transparent society in our country Cameroon (FEMEC is the Cameroon Federation of Protestant Churches and Missions).
The Youths should:
Know their rights and be courageous to stand by them.
Be modest in their doings, respectful, submissive, and patient.
Not emulate corrupt examples, practiced by our parents, friends and people in authority (1 Cor. 15:33).
Be honest and retire from giving and taking bribes.
Be united and fight for justice and equality for the good of the society.
Be imaginative, creative, and hard working to be self-reliant.
Not practice favoritism, nepotism, tribalism, and racism.
Refrain from forging documents from various purposes like:
Birth Certificates
Marriage Certificates
School Certificates
Traveling Certificates (VISAS)
Employment Certificates
Counter-feinting, etc.
Not be beneficiaries of any corrupt act.
Live their lives as the gospel of Christ requires (Phil. 1:27).
We the participants of this forum, hereby commit ourselves to this code, as we want the change to begin with us.
Done in Buea/Cameroon, on August 8, 2002.
References
Akonumbo, A. N. (2006). HIV/AIDS law and policy in Cameroon: Overview and challenges. African Human Rights Law Journal, 6(1), 85-122.
Allen, T. (2006). AIDS and evidence: Interrogating some Ugandan myths. Journal of Biosocial Science, 38(1), 7-28.
Awuba, J., & Macassa, G. (2007). HIV/AIDS in Cameroon: Rising gender issues in policy- making. African Journal of Health Sciences, 14(3), 118-128.
Awasthi, K. R., & Awasthi, M. S. (2019). Behaviour change communication/social Marketing in HIV, AIDS. Health Systems Policy Resources, 6(1), 80.
Beer, M., Finnström, M., & Schrader, D. (2016). Why leadership training fails—And what to do about it. Harvard Business Review, 50-57.
Bonje, E. K., Khan, E. M., & Miller, L. (2012). End-of-project report. Web.
Birx, D L. F.Y. 2019 PEPFAR planned allocation and strategic direction. Web.
Boyer, S., Marcellin, F., Ongolo-Zogo, P., Abega, S. C., Nantchouang, R., Spire, B., & Moatti, J. P. (2009). Financial barriers to HIV treatment in Yaounde, Cameroon: First results of a national cross-sectional survey. Bulletin of the World Health Organization, 87, 279-287.
Bowring, A. L., Ketende, S., Rao, A., Njindam, I. M., Decker, M. R., Lyons, C.,… & Fouda, G. (2019). Characterizing unmet HIV prevention and treatment needs among young female sex workers and young men who have sex with men in Cameroon: A cross-sectional analysis. The Lancet Child & Adolescent Health, 3(7), 482-491.
Cohen, J. (2005). The less they know, the better: Abstinence-only HIV/AIDS programs in Uganda. Human Rights Watch, 17(4), 1-10.
Derose, K. P., Kanouse, D. E., Kennedy, D. P., Taylor, A., & Patel, K. (2010). The role of faith-based organizations in HIV prevention and care in Central America. Web.
Desclaux, A., Msellati, P., & Sow, K. (2011). Genre et accès universel à la prise en charge. Dans Les femmes à l’épreuve de VIH dans les pays du Sud. Paris, France: ANRS Collection Sciences Sociales et Sida.
Eboko, F., Abé, C., & Laurent, C. (2010). Accès décentralisé au traitement du VIH/sida. Evaluation de l’expérience camerounaise. Paris, France: ANRS Collection Sciences Sociales et Sida.
Essoh, G. E. N. (2020). Beautifying controversial African politicians through metaphors: A study of the Cameroonian media discourse. In Deconstructing Images of the Global South Through Media Representations and Communication (pp. 253-272). Harrinsbourg, PA: IGI Global.
Ferris, E. (2005). Faith-based and secular humanitarian organizations. International Review Red Cross, 87, 311.
Fondoh, V. N., & Mom, N. A. (2017). Mother-to-child transmission of HIV and its predictors among HIV-exposed infants at Bamenda Regional Hospital, Cameroon. African Journal of Laboratory Medicine, 6(1), 1-7.
Gray, P. B. (2004). HIV and Islam: Is HIV prevalence lower among Muslims? Social Science & Medicine, 58(9), 1751-1756.
Green, E. (2003). Rethinking AIDS prevention: Learning from successes in developing countries. Westport, CT: Praeger Publishers.
Green, E. C. (2001). The impact of religious organizations in promoting HIV/AIDS prevention. Challenges for the church: AIDS, malaria & TB. Westport, CT: Praeger Publishers.
Green, E. C., & Ruark, A. H. (2016). AIDS, behavior, and culture: Understanding evidence-based prevention. Abingdon, United Kingdom: Routledge.
Haddison, E. C., Nguefack-Tsagué, G., Noubom, M., Mbatcham, W., Ndumbe, P. M., & Mbopi-Kéou, F. X. (2012). Voluntary counseling and testing for HIV among high school students in the Tiko health district, Cameroon. Pan African Medical Journal, 13(1), 1-10.
HIV Free project CBCHB 2019 report. (2019). Web.
Hong (2012). Best practices in managing faith-based organizations through charitable choice and faith-based initiatives. Journal of Social Service Research, 38(2), 130-143.
Holland, C. E., Papworth, E., Billong, S. C., Kassegne, S., Petitbon, F., Mondoleba, V.,… & Eloundou, J. (2015). Access to HIV services at non-governmental and community-based organizations among men who have sex with men (MSM) in Cameroon: An integrated biological and behavioral surveillance analysis. PLoS One, 10(4), e0122881.
Ko, K., & Moon, S. G. (2014). The relationship between religion and corruption: Are the proposed causal links empirically valid? International Review of Public Administration, 19(1), 44-62.
Koenig, H.G. (2009). Research on religion, spirituality, and mental health: A review. The Canadian Journal of Psychiatry, 54(5), 283–291.
Kron, J. (2012). In Uganda, an AIDS success story comes undone. New York Times.
Lazareva, I. (2017). Cameroon’s sex workers brush off beatings to send clients for HIV tests YAOUNDE. Web.
Lazzarini Z. (1998). Human rights and HIV/AIDS. Discussion papers on HIV/AIDS care and support. Philadelphia, PA: The Synergy Project.
Lewis, J. S. (2019). Corruption, reform, and revolution in Africa’s third wave of protest (Unpublished doctoral dissertation). The University of Maryland, Maryland.
Luma, H. N., Jua, P., Donfack, O. T., Kamdem, F., Ngouadjeu, E., Mbatchou, H. B., & Mapoure, Y. N. (2018). Late presentation to HIV/AIDS care at the Douala general hospital, Cameroon: Its associated factors, and consequences. BMC Infectious Diseases, 18(1), 298.
Macintyre, K., Brown, L., & Sosler, S. (2001). “It’s not what you know, but who you knew”: Examining the relationship between behavior change and AIDS mortality in Africa. AIDS Education and Prevention, 13(2), 160-174.
McPake, B., Brikci, N., Cometto, G., Schmidt, A., & Araujo, E. (2011). Removing user fees: Learning from international experience to support the process. Health Policy and Planning, 26(2), 104-117.
Meekers, D., & Calvès, A. E. (1997). Main ‘girlfriends, girlfriends, marriage, and money’: The social context of HIV risk behavior in sub-Saharan Africa. Journal of Transport & Health, 7, 361-75.
Murphy, E. M., Greene, M. E., Mihailovic, A., & Olupot-Olupot, P. (2006). Was the “ABC” approach (abstinence, being faithful, using condoms) responsible for Uganda’s decline in HIV. PLoS medicine, 3(9), e379.
Nakpodia, F., Shrives, P. J., & Sorour, M. K. (2020). Examining the link between religion and corporate governance: Insights from Nigeria. Business & Society, 59(5), 956-994.
National AIDS Control Committee. (2010). The impact of HIV and AIDS in Cameroon through 2020. Central Technical Group, 21, 1-30.
Ndoye, N. I., Souleymane, M., Ndiayee, S., Niang, C., Sarr, F.,… & Caraël, M. (1999). Low and stable HIV infection rates in Senegal: Natural course of the epidemic or evidence for success of prevention? Aids, 13(11), 1397-1405.
Ndumbe P. (1999). Women and access to health services in Cameroon. Studies and Works from Social Policy Research Network No 3, West and Central Africa, 5-7.
Nduku, E. (2015). Corruption in Africa: A threat to justice and sustainable peace. Geneva, Switzerland: Globethics.net.
Ngangue, P., Bedard, E., Ngueta, G., Adiogo, D., & Gagnon, M. P. (2016). Failure to return for posttest counseling and HIV test results at the prevention and voluntary testing and counseling centers of Douala, Cameroon: An evaluation of a routine five-year program. AIDS Research and Treatment, 1-10.
Nguefack, H. L. N., Gwet, H., Desmonde, S., Oukem-Boyer, O. O. M., Nkenfou, C., Téjiokem, M.,… & Alioum, A. (2015). Estimating mother-to-child HIV transmission rates in Cameroon in 2011: A computer simulation approach. BMC infectious Diseases, 16(1), 11.
Niebuhr, B., Gruber-Tapsoba, T., Degrando, D., & Gesing, K. (2004). Role of social marketing in HIV/AIDS prevention in Cameroon. Frankfurt: KfW Bankengrupee.
Ochillo, M. A., Van Teijlingen, E., & Hind, M. (2017). Influence of faith-based organisations on HIV prevention strategies in Africa: A systematic review. African Health Sciences, 17(3), 753-761.
O’Donnell, J., & Gramer, R. (2018). Cameroon’s Paul Biya gives a master class in fake democracy. Foreign Policy. Web.
Olivier, J. (2011). Religion and policy on HIV and AIDs: A rapidly shifting landscape. In Haddad, B. (Ed.), Religion and HIV and AIDS. Charting the terrain (p. 81-104). Pietermaritzburg, South Africa: University of KwaZulu-Natal Press.
Schilder, K. (1988). State formation, religion, and land tenure in Cameroon. Leiden, The Netherlands: African Studies Centre.
Soong, C., & Shojania, K. G. (2020). Education as a low-value improvement intervention: often necessary but rarely sufficient. BMJ Quality & Safety, 29(5), 353-357.
Slutkin, G., Okware, S., Namaara, W., Sutherland, D., Flanagan, D., Carael, M., Blas, E., Delay, P., & Tarantola, D. (2006). How Uganda reversed it’s HIV epidemic. AIDS and Behavior, 10(4), 351–360.
Stückelberger, C. (2003). Continue fighting corruption. Impulse, 2(3), 12.
Terry, J. D., Smith, A. R., Warren, P. R., Miller, M. E., McQuillin, S. D., Wolfer, T. A., & Weist, M. D. (2015). Incorporating evidence-based practices into faith-based organization service programs. Journal of Psychology and Theology, 43(3), 212-223
Tiendrebeogo, G., & Buykx, M. (2004). Faith-based organisations and HIV/AIDS prevention and impact mitigation in Africa. Transit Review, 7, S361-375.
Tih, P. M. (2018). Role of FBOs in HIV Care and prevention in Cameroon: The case of CBC health Services [Video file]. Web.
UNAIDS (2000). Uganda epidemiological fact sheet on HIV/ AIDS and sexually transmitted infections: 2000 update. Geneva: UNAIDS.
UNAIDS & WHO. (2004). 2004 UNAIDS, WHO epidemiological fact sheet — on HIV/AIDS and sexually transmitted infections: Cameroon: UNAIDS & WHO.
UNAIDS. UNAIDS data 2018. Geneva: UNAIDS; Web.
Vision of Ambazonia, by Tabe. (2018). Web.
Wawer, M., Sserwadda, D., Gray, R. H., Sewankambo, N. L, Nalugoda, C., … & Lutalo, T. (1997). Trends in HIV-1 prevalence may not reflect trends in incidence in mature epidemics: Data from the Rakai population-based cohort, Uganda. AIDS, 11(8), 1023-1030.
Welty, T. K., Bulterys, M., Welty, E. R., Tih, P. M., Ndikintum, G., Nkuoh, G.,… & Wilfert, C. M. (2005). Integrating prevention of mother-to-child HIV transmission into routine antenatal care: The key to program expansion in Cameroon. JAIDS Journal of Acquired Immune Deficiency Syndromes, 40(4), 486-493.
HIV/AIDS is referred to as a long-wave event because of its large-scale effects. Since the emergence of HIV/AIDS in the 1980s, the disease has prevailed for a long-time and with wide-spread repercussions (Barnett 2006). Considering that HIV/AIDS has no cure, the disease is now a pandemic due to its disastrous effect on those infected and affected by the same (Barnett 2006). In fact, the prevalence and effects of HIV/AIDs are compared to other long-wave events such as global warming, cancer and obesity.
Nonetheless, there are features that make HIV/AIDS a long-wave event. For example, the origin of the disease has always remained a mystery and a contentious issue (Barnett 2006). It has taken a long time for any efforts to materialize in containing or preventing the spread of HIV/AIDS. In fact, it has remained difficult to mobilize resources to address HIV/AIDS. In addition, dealing with myths and consequences associated with the HIV/AIDS pandemic is a long-term challenge.
There are political and governance implications of HIV/AIDS in states with high levels of infection. Moreover, HIV/AIDS has been associated with slow economic growth and social tensions. In this context, the government’s capacity to facilitate governance is hampered by diminishing military preparedness and increasing cost of social welfare. Reports from Zimbabwe and South Africa suggest that governance is hampered by deaths of politicians, business persons and civil servants (Barnett 2006). With the death of politicians and civil servants, it becomes a challenge to develop. This is because of the continuous disruption of the government’s goals in implementing policies is unnecessary.
The increased infections of HIV/AIDS in developing countries, especially in South Africa, imply a likelihood of political and social unrest (Smith & Whiteside 2010). Reports from National Strategic Planners in South Africa suggest that issues of HIV/AIDS are a common feature among the middle-class and political elites (Barnett 2006). In this regard, there is a high probability of a political struggle to control resources directed to HIV/AIDS management programs. In fact, reliable information from the United States departments suggests that the struggle to manage resources for HIV/AIDS programs undermines democracy (Barnett 2006).
There are concerns that HIV/AIDS can be a source of potential security threat (Elbe 2011). Indeed, such concerns are valid, considering that the pandemic has political and governance implications (Smith & Whiteside 2010). In any case, the lack of social and political goodwill to accommodate those affected and infected by HIV/AIDs has always led to stigmatization. There were claims that HIV/AIDS will create 42 million orphans by the end of 2010 (Barnett, 2006).
Although such reports are yet to be validated, concerns about terrorism using the orphans as militia have been fronted by security policy-makers. An increasing number of people infected and affected by HIV/AIDS create a possible recruitment pool for terrorists (Barnett 2006; Elbe 2011). However, this is possible if effective social and political interventions are not established on time.
As indicated earlier, the connection between HIV/AIDS and political conflicts is a challenge to peace-building efforts. Ensuring that victims of HIV/AIDS are treated equally in society is a political priority. In addition, any effort directed to address HIV/AIDs in the society can be used in intervening for Ebola crisis in West Africa. The Ebola crisis has similar characteristics of a long-wave event. Moreover, the Ebola crisis poses challenges to global security issues if adequate interventions are not established.
References
Barnett, T 2006, ‘A long‐wave event. HIV/AIDS, politics, governance and ‘security’: sundering the intergenerational bond?’ International Affairs, vol. 82, no. 2, pp. 297-313.
Elbe, S 2011, ‘Pandemics on the radar screen: health security, infectious disease and the medicalisation of insecurity,’ Political studies, vol. 59, no. 4, pp. 848-866.
Smith, J H & Whiteside, A 2010, ‘The history of AIDS exceptionalism,’ Journal of the International AIDS Society, vol. 13, no. 1, pp. 47.
This paper is an overview of the law in Qatar; one of the nations ruled entirely by Islamic principles. The scope of the paper will mention some of the fundamentals of the same laws considering that they are far much too broad to be discussed in detail. Basically, the nation has laws that govern all the aspects of the life of its people, such as the economic, social, political, and civil affairs. It is interesting to note that Qatar has one of the most traditional principles concerning labor and the culture of the people (Dowling, 2001).
For instance, the labor laws are strict on any foreigners while the same laws restrict people on their dress codes. For those people who would wish to tour Qatar, there is the need to consider that the nation has stringent laws that govern immigrants, especially according to their HIV/AIDS statuses. Therefore, this work will discuss the fundamental laws concerning immigration laws, nationality issues, the dress code of the people, and sexual orientation, among others. There is also the need to recognize that Qatari laws are founded on the fundamentals of Islamic laws called Sharia (Sullivan, 2015).
Islamic law, Sharia is the basis of both family criminal acts law in Qatar. The Islamic court, which follows the outline of the Sharia laws is the established institution concerned with the settling of conflicts in Qatar, just like in many other Islamic countries. During Ramadan, Qatar requires that all her citizens fast from dawn to sunset. The nation grants visas cards at some of its major border entry points, some of which visitors make prior applications for. Qatar has tight principles and restrictions on HIV/AIDS visitors (Dehays, 2012).
It does not allow HIV/AIDS positive visitors to reside in the country. Therefore, the nation ensures a thorough medical examination of all visitors that plan to stay in the country for long periods of time. Tourists are taxed as per the customs regulations for carrying goods at any point of entry (Dehays, 2012). Trafficking of illegal substances as well as bringing of illegal substances such as alcohol is against the Qatari laws and its violation results in a death penalty or any other form of tough punishment.
Getting in Qatar with pets such as cats and dogs is allowed after an acquisition of a permit for import from the Ministry of Agriculture (Dehays, 2012). The law requires that the visitors submit details of the pet to the relevant authorities, which may include the vaccination forms. More so, according to the law in Qatar, residents should carry identity cards with them, apart from children below the minority age of eighteen years. The identity card is essential for the dealings with Government Ministries day in, day out because of its usefulness in registration social places. The law dictates that Qatari nationals should only hold their citizenship (Online Qatar, 2015).
Hence, it does not accommodate dual nationality. Therefore, one has to give up one of their nationality as soon as the Qatari authorities discover the existence of such an incidence. Therefore, citizens that have dual nationalities should look into such an issue before they stage their traveling activities. Short-term visitors should acquire an international driving permit that is valid before getting in Qatar as per the traffic laws.
They are not allowed to use home country driver’s license while driving, neither should they argue on roads over traffic occasions. Drivers involved in any vehicular accidents are held accountable for the injuries of the victims of the same circumstance. Additionally, any vehicle having more than five years of age is not roadworthy in consideration, and, therefore, cannot be imported in Qatar (Online Qatar, 2015). Further, the country assumes no tolerance legislation concerning people who drink and drive. Offending this law culminates into being banned from driving.
Talking of dressing code, Qatar does not accommodate dressing in a provocative manner. It does not permit wearing of sleeveless shirts and blouses, shorts or halter tops (Online Qatar, 2015). However, there are some considerable levels of acceptance of bathing costumes, especially at swimming pools and beaches. Therefore, there is a need that people in the country consider high levels of observance to Islamic principles. Language and gesture usage ought to be friendly. Insults, whether verbal or non-verbal, can consequently lead to imprisonment.
Homosexuality is termed as a criminal offense among other offences in Qatar. Involvement in the same activities together with intimacy in public may lead to subjection to imprisonment (Sullivan, 2015). Women are allowed to contest for leadership positions in Qatar. They are allowed to vote as well as running for public offices in the country, although not allowed to go out driving with any male companion, and just like others, they should dress modestly. Qatar government regulates crimes by the use of Sunni law based on religion. People are allowed to follow Christianity, Islam, Hinduism, among other religions, so long as they do not offend public order (Qatar Online, 2015).
In this case, one should be keen while discussing issues to do with religion in public. One is neither allowed to convert a member of one religion into another nor share religious ideas between people belonging to different lines of faith, as it is against the Qatari law. People are cautioned to be responsible and take care of their property to avoid petty theft cases. Furthermore, the nation does not allow people to involve in illegal businesses. Lastly, violation of any law in Qatar will lead to nothing else but arrest or prosecution.
In conclusion, this paper has reviewed some of the fundamental Qatari laws and precisely touched the social spheres of life in the country. Just like any other state, there are clear implications that lawbreakers pay the price, which is a jail term or other punitive measures. However, the laws of the country have an extra-disciplinary action instituted against extremists, the death penalty. It is also conclusive enough that the country’s laws have their basis in the religious concepts and beliefs, mostly the Sharia.
However, the laws of the country show some considerable levels of respect for the religious orientations of non-Muslim residents and visitors. Qatari citizens are obliged to dress appropriately according to the national dress codes and respect one another lest they face the accrued consequences. All visitors to the country should take caution against driving rules because there are strict punitive measures against people who violate the traffic laws.
References
Dehays, O. (2012). Qatar’s new Tourism law – restoring confidence. Travel Law Quarterly, 4(3), 240-241.
Dowling, D. C. (2001). The Practice of International Labor & Employment Law: Escort Your Labor/Employment Clients into the Global Millennium. The Labor Lawyer, 1-23.
Since the start of HIV pandemic, the humanity aimed to regulate and minimize the spread of the infection. Consequently, the corresponding laws were accepted. Unfortunately, these laws are far from being perfect, but the attempts to work out the rational system are held. This paper is aimed to offer the rational approach for the elaboration of HIV Disclosure Laws.
Introduction
Currently, about Forty million people all over the world are infected with the HIV. It is stated, that about six percent will never inform their intimate partners about the infection. Actually, numerous efforts have been made recently to elaborate and implement the HIV/AIDS law. The disclosure law was signed in 1990. It reasoned the stir among the citizens of the USA, who were surprised by this signing. People considered, that the accepted law included many holes regarding the matters of HIV/AIDS disclosure, because it lacked inclusive consideration. Some people considered, that if HIV infected people become obliged to tell the others of their decease, they will be more subjected to discrimination and segregation. Fundamentally, this law became the matter, that filled some holes, but simultaneously reasoned the new problems, and originated predicament.
Current HIV Disclosure Law
The stir and the voices of apprehension and dissatisfaction arose since the HIV pandemic appeared, so the virus infected people started feeling discriminated, and most did not tell their intimate partners of the infection. The people, who became the victims, as they were unaware of the danger of the infection, finally appeared in the center of attention. Since 2004, it has been regarded as a felony when the infected person, clearly realizing about his or her infection (HIV positive), and does not inform his/her partner, and when an infected person aims to pass it on.
Some people stand for this law, as the partners should be aware of the health condition of their intimates. Others argue that there is strong lack of specificity in the law. It also lacks the essentials of historical medical ethics, and the apprehension with the uproar of the HIV/AIDS dishonor.
The current HIV/AIDS Disclosure Law also originates some controversial matters regarding the nowadays beliefs and the beliefs originated previously. The disclosure matters confront conventional medical ethics. The contemporary medical practice is based on the ethic code, which touches upon the patients’ confidentiality, their approval, and their deterrence from harm. Proceeding from these principles, the Disclosure Law is often regarded as the invasion of privacy. Thus, if an infected person is obliged to tell his or her intimate partner of the infection, the person may challenge the further rejection or discrimination, depending on the reaction of the partner.
A research was held among the infected persons. It revealed that seventy fiver percent of the infected chose to inform their partners. As for the rest fifteen percent, they grounded their refuse on the fear to break serious relations. Also, they mentioned, that they just did not wish to be treated like sick persons, or experience the treatment as to the person who needs sympathy.
The Rational Law of HIV Disclosure
The key requirements for the HIV Disclosure Law should be the following:
Provide the decrease of infection threat
Do not harm the human dignity and privacy
The intents of concealing the fact of infection should be restrained.
Consequently, the rational law – is the law, that should be based on the medical ethics and regard the human dignity as the highest precious. In order to prevent the disclosure as the instance of privacy violation, the infected person should take the responsibility of the sexual contact safety, and take all the safety measures to prevent the partner’s infection. The threat of infection stays minimal, but it can not be completely undermined. The matter should be not in the question of whether the infected person informed the partner, but whether the safety measures were taken, if the person was aware that he or she is infected.
As for the matters of harm, it is necessary to mention, that twenty-four states in the U.S. regard the HIV transmission by consensual sexual activities as the criminal offence. These activities are prohibited by the Disclosure Laws and the definite risk of virus transmission is regarded to be tenuous in the best situation. It is necessary to emphasize, that few other law spheres impose such severe sanctions for physical harm. As for the harm to human dignity, it should be stated, that still, the responsibility should be imposed only on the infected person, as the disclosure is the double edged sword, as on the one hand it violates privacy, and on the other hand it endangers the health of the infected person’s partner. The balance should be found, as it is originally impossible to defend the privacy and health simultaneously in this situation.
The rational Law should not restrict and prohibit the matters that are difficult to regulate. Sexual contact can not be forbidden just because of the fact, that someone does not wish to tell he/she is HIV infected. The following example of Disclosure Law should be considered as the example of mistaken approach: In Ohio, undisclosed HIV exposure by sexual contact is regarded as criminal assault. (1) If convicted, the punishment is two to eight years of imprisonment. (2) Prohibited activities entail anal, vaginal, and oral contact. (3) The Law makes no distinction between higher-risk sexual activities such as anal sexual contact and lower-risk such as oral sex.
Here is another mistaken approach to the sexual contacts among HIV infected: Florida is one of several states that have laws making it illegal for people who know they are infected with HIV to not tell sexual partners. The crime does not qualify one to be designated a sexual offender or sexual predator, under state law.
As it is medically confirmed that HIV transmission may be undermined, if retorting to the safety measures, the approach of total prohibition of sexual contacts is originally wrong. The prohibition of sexual contacts means the intervention into the private life, and restriction of personal liberty of the infected person: this is the approximate definition of discrimination. If the USA is struggling with the matters of discrimination and segregation, the sexual contacts should not be prohibited if condoms are used.
The approach of prohibiting the sexual activities is mistaken in the root, as it is impossible to control people’s nature. There is also no need to make the distinction of the sexual activities (vaginal, oral, anal) as the credibility of infection transmission is high, if condoms are not used.
The third point of the rational law system includes the intent of concealing the fact of being infected. Unfortunately, any state supports the idea of the total responsibility for the person for the sexual contact safety. The intent to conceal the fact of being infected almost everywhere is regarded criminal, as it is stipulated, that a human should be aware of the sexual health of his or her sexual partner. This way, the privacy and medical ethics is violated. On the other hand, if the entire responsibility for sexual safety were imposed on the infected person, there would be no need to regard the intent to conceal the fact of being HIV positive as the criminal offence.
Conclusion
As it has been stated, the matters of privacy and safety are on the different scale pans. It is necessary to find the balance between these two matters in order to promote essential safety level, and not to violate the infected person’s privacy.
The most credible approach, that allows to kill two birds with the only stone, is to impose the entire responsibility for the safety on the infected person. Consequently, there will be no need to inform the partner, and disclose the fact of infection, but in the case of infection transmission, the infected person will be regarded guilty for not using the safety measures.
This paper contains a report for senior managers of Genco, a pharmaceutical company involved in selling and distribution of HIV/AIDS drugs in Malaysia. The management of Genco Company has entered an agreement with Eurodollars Investment Bank to open up distribution networks in Malaysia in order to have market dominance in the area. There are many legal issues which are involved in the transaction and which should be addressed by Genco Company when investing in Malaysia. The fundamental issue that the company should consider is the laws of the country in which the business channels will be situated. This is because the legal systems of any nation are very critical in determining whether a company is going to be successful or whether its operations will be terminated by the relevant authorities due to failure of conforming to a certain procedure.
The first step for Genco Company should be determining whether the business is authorized to operate in Malaysia. If the business is legally accepted in Malaysia, the management of Genco Company should then proceed in determining the type of business it should set up in Malaysia. There are many types of business options, which the company can open. These include setting up a partnership with local companies through a common firm, setting up an association, operating as a single entity, setting up a foundation, and setting up a private limited company. A private limited Company would be the best option for Genco limited because it would ensure that the branch, which is opened in Malaysia, is limited by the shares but the original capital, which has been invested, is secure (Jennings 78).
As a private limited Company, Genco shares will not be traded in the Malaysian Stock Exchange because the requirements for trading business are lighter than those of public limited Company are. Moreover, the Company should proceed in registering for the necessary business permits in order to have legal access for conducting business in Malaysia. Some of the legal requirements, which the company should undertake, include the Articles of Association and the Memorandum of Association. The Articles of Association is a document, which contains the fundamental law governing the conduct of business in Malaysia while the Memorandum of Association is a document, which contains the activities and the operations of a business (Meek and Chartered Institute of Marketing 56).
Companies act
According to companies Act 1965, of the Malaysian constitution, any business operating in the Malaysian territory should be registered through the registrar of companies within 30 days after the commencement of the business. Genco management should thus move with speed to register the company in order to show its need to conform to the rules governing activities of the business in the company. Upon the date of registration, the company would be able to obtain Certificate of Registration, which shows that the company has been authorized to operate in Malaysia. The management of Genco Company should be keen on setting out the date of registration because it helps to determine the period, which the business will be legal to operate in the country (Brigham, Garpenski, & Daves 130).
Any business operating in Malaysian territory can also be terminated in the following circumstances, if baleful information was delivered during the period of registration. Secondly, the shareholders for Genco Limited should also be aware of the expiry of the period set out in the registration. The management should be keen on renewing the period of operation to prevent the business operations from being terminated. Furthermore, the management should also be aware of the liabilities, which the company would have to bear in case one of the members of the company commits an offence as defined by Companies Act 1965, Section 17(1) of the Malaysian constitution (Jennings 70).
In order for the company to begin its operations, it should consider issues concerned with the purchase of assets. The most important legal concern would be obtaining an asset purchase agreement. This is a legal document, which acts as proof that a contract has been entered between an asset buyer and the seller. The company may also consider leasing some of assets instead of buying them and this document can still be enforceable. The obligations of acquiring an asset should be followed to the latter to ensure that there is no breach in the contract. The document for asset purchase agreement should be signed on the day of the transaction to enhance compliance with the legal framework. The government of Malaysia to enhance integrity and utmost good faith should then approve the assets. This enhances prevention of any liability or even violation of the existing Malaysian laws on the acquisition of the Assets. Any irregularity should be dealt with care to prevent restriction to use the Assets (Meek and Chartered Institute of Marketing 51).
Contractual issues
Apart from Asset Purchase Agreement, there are many contracts, which the company is supposed to enter. The management of Greco Company should understand that a contract has several elements. These elements include; offer and acceptance intention to enter into a legally binding agreement, the legal capacity and specific contractual considerations. Before the company has set up its branches in Malaysia, it should ensure that a contract has been entered. This is because if the company fails to follow the due process of entering into any contract, the process may be termed as void due to any breach of the contractual process. The first step in entering into a contract is the offer and the willingness to enter into negotiations. An agreement is not legally binding unless there is an offer, which is legally binding (Brigham, Garpenski, & Daves 132).
In the process of selling its products, the company should make sure that any offer has been communicated in due time in order to avoid any irregularity which might occur in the process. Although an offer can be withdrawn from, it should be communicated in due time. According to the Malaysian law, invitations to offer a product from a company to consumers should not be misleading but should entail unequivocal agreement between the parties. This is because in so doing a breach may be committed before the contract becomes fully enforced.
The second consideration when entering into a contract is the intention to create relation, which is legal. An agreement between two parties does not solely show that the individuals have entered into the contract. The parties entering into a contract should set up a date when to sign a contract. This should be communicated in time in order to show that there is an intention to create a relation, which is legal. There should be a rebuttable intention to enforce the agreement into a legal contract. The intention to enter enforce the contract should be communicated to the party who has the offer in due time (Jennings 71).
The third stage in entering into a contract is consideration of the agreement. The price, which has been offered, should be of value and this is not limited to monetary value. A benefit or an interest to be gained after signing the contract can be taken as a consideration. The other element to be considered in a contract is the contractual capacity. The company should always avoid entering into a contract with people who have no capacity to enter into a contract such as the minors, companies that are bankrupt and corporations. The capacity question in a contract often arises after the contract has been signed (Jennings 69).
Any breach of any contractual term may amount to a breach of the contract. The type of a breach may include the damages for compensation. In case of any monetary loss through a breach of contractual term, compensation can occur. The breach, which was foreseeable, would be compensated through incidental damages. The parties may also pay the breaches through the punitive damages. This helps to bar an individual from committing the same offense in future. The damages, which have been specified in a contract, are termed as liquidated damages and are compensated through a breach of a contract. Despite a breach of a contractual agreement by both parties, usually a court of law determines the party, which violated the terms and then imposes punishment on that party (Brigham, Garpenski, and Daves 134).
Mergers and Acquisitions
Mergers and acquisitions can be described the process of combining more than one different business entity to a common venture. If the business purchases another business entity, then the process is referred to as an acquisition while a merger can be defined as the process of combing two or more business with the objective of working together under the same objective. There are many legal issues, which Genco Company should consider before acquisition of another business entity. Merger and Acquisition transactions are the very complex and critical as complex issues may arise during the period of business transactions. The process of acquiring a new company begins with the tender offer from the target company. The management of Genco Company should begin with preliminary investigation as to whether the target business owns real assets and properties in order to avoid liabilities, which are foreseeable (Walker 27).
The first stage of merging with a company should begin with the acceptance of terms of offer, which have been put in place by top managers. These steps should be in an attempt to negotiate the tender offer because it may be too high for the company to afford. Many other companies may also be interested in the company and it is thus important to choose the lowest bid possible. In particular, there arise many legal issues from the company, which is merging with another. For instance, the question about the employees jobs should be discussed and negotiated before the company has acquired the necessary legal authority to commence its business. The jobs might be at stake in many ways and therefore Genco Company should plan to rehire them or even dismiss them with a reasonable package for compensation.
In cases of hostile takeover from another company, Genco management should adopt a poison pill strategy to discourage the other company from any attempt to acquire any asset from the company, which had offered to be taken. A poison pill may be either a flip in or a flip over. A flip in gives the shareholders authority to trade many shares with a discount while a flip over gives the stockholders authority to buy shares through a price which has been discounted by a merger. A poison pill enhances dilution of the shares and the right of ownership of the acquirer through buying more shares. This gives authority to the company, which is merging with the other to have more authority and power and thus prevent any form of transaction. The shareholders will then have the right to purchase the stock thus giving them control of business.
Merger acquisitions by cross border Companies are very unique and different from other forms of mergers. This is because a Company is supposed to enter into a lot of legal framework before owning a business. Many regulatory bodies in foreign countries often scrutinize the business, which merge to become a single entity. This is because the main objective of the government is to protect the consumers and shareholders from companies and firms which would like to merge to take advantage of the local consumer. Nevertheless, in mergers and acquisitions, the company should ensure that it follows the right legal documentation to avoid conflict with legal enforcement agencies (Jennings 77).
One of the risks of mergers and acquisitions is that they pose a great lose to a business during a breakup. One of the rising issues is that the demerged firms become smaller than the parent company and this prevents them from getting the benefits of being a large entity. To begin with, the credit institutions will not be willing to lend these firms because their cash flows will have minimized. Secondly, having a small company would also mean that the firms would lack representation in major indexes. Investors and many credit organizations always tend to depend on the companies, which are on the major indexes. Failure to have representation in these indexes would lead to lack of investment.
In case Genco Company has broken up with a company, there are several methods, which the company can use to restructure itself so business can remain as usual. The management of the company may decide to do an outright sell off. This entails getting of unwanted subsidiary for the purpose of raising cash for the company. Secondly, the company can still get an equity carve-out, which would help to boost business. Although a curve out helps to generate cash through the trade of shares from the subsidiary, it is very risky because the owners of the business may develop a loyalty, which is divided. The management of the company may also decide to opt for a spinoff. This helps the business to depress the valuation of the shares and increase the subsidiaries created in the business (Meek & Chartered Institute of Marketing 49).
Laws on competition of firms
There are several laws, which have been enacted to regulate the economic competition of firms and businesses. Firms, which restrict healthy competition with the need to monopolize often, face many legal issues. Although the fundamental objective for Genco Company is having market dominance in the sale of drugs in Malaysia, the company should avoid all forms of strategies to monopolize its business. The competition laws help to secure the welfare of the consumers through prevention of any merging options, which can leading to dominance of the market and lessen competition of the companies (Daft 98). Agreements and practices, which encourage monopoly, are prohibited in many parts of Malaysia.
Perfect monopoly gives the companies power to dominate the market and the welfare of the consumers. That is why it is very easy for monopolies to impose huge prices of commodities to the consumers. In addition, monopolies also dictate the allocation of products to consumers and prevent healthy competition, which is necessary for the growth of the economy. Besides, monopolies are also responsible for boycotts of products in the market. This deprives consumers of the necessary products, which they should have for their daily welfare in the society. This is also coupled with laws and agreements, which prevent other competitors who lack market power to continue with their business (Karminder and Aswathappa 84).
Perfect monopolies are also adamant in price violations such as offering discriminatory prices. The management of Genco Company should avoid any form of violation, which would lead to customer discrimination. Furthermore, if a company has entered into an anticompetitive agreement with any other company or entity, it can still be liable for violation of the existing legal frameworks on the operations of a monopoly. Any agreement, which helps to control prices, is also taken as a violation by a monopoly. The issue of the behavior of cartels is also prohibited in the country where the business is legal. Some of the behavior of the cartels includes lack of market sharing, rigging of the bids and limitation of the supply of goods and services. All these prevent perfect competition of businesses (Meek and Chartered Institute of Marketing 46).
When signing franchise agreements, the management of Genco should scrutinize all the provisions leading to the signing of the agreement. This is because some of the provisions of a franchise agreement limit competition and the term of operation. Some monopolies also misuse their position of dominance in the market to have gains, which prevent perfect competition. For instance, an agreement to impose huge prices to the consumers may amount to monopolization. Mergers and Acquisitions are also known to increase monopoly through reduction of perfect competition. The management of Genco Company should therefore analyze all the legal issues and avoid becoming a monopoly (Jennings 72).
Product liabilities
Genco Company should be able to bear a liability of the products, which it offers to the consumers. Under the legal requirements of Malaysia, any manufacturer or distributor of any product is liable for assuming the liabilities of the injuries, which are caused by the usage of the products to the consumer. Every individual in the supply chain is supposed to take care of the products to avoid any injury to the consumer. Secondly, there is a breach of warranty, which binds the seller and the distributor from the trade of the products. In case of any damage, there are factors, which should be considered before a company bears a liability.
Misrepresentation, which includes a false statement about a product, can also amount to a breach. In addition, the Genco Manufacturers can also bear over the defects caused by design and manufacture. A design defect entails manufacture of a product, which is according to specifications but is dangerous for usage. On the other hand, when a product fails to conform to specifications and standardization requirements, it also fails to achieve it objective and therefore contains defects of manufacture. The manufacturer is the liable entity when it comes to defects, which are caused by manufacture of a product to a consumer (Kubr 67).
The manufacturer should make the products in such a manner that they have safety for their users. There should also be proper practices of handling products from the manufacturers to increase safety in the usage of the products for the consumers. In order to increase the safety of the products, it is important for the company to ensure that an insurance cover has covered every product.
Activity based budgeting system
Within Malaysia, firms are encouraged to undertake activity based budgeting systems. The authorities insist on this system because it ensures there is transparency in the financial statements released by the firms. The new system that has been developed uses the conventional approach in budgeting. The system works better, where the resources consumption is grater than the output level for the company (Drury 105). However, the system is not designed to measure the indirect costs, which occur in the accounting department thus ensuring a good measure of the output relationships in the accounting department. The budgets cannot be based on other relationships since factors such as costs are poor measurements of the performance of the business. These budgets also provide the relevant information about the management of the support activities.
The system uses the incremental basis in the preparation of the final budget. The importance of this basis is to enable the indirect costs and the support activities to be accounted in the final draft. Every annual budget thus contains the existing operational activities for an organization while at the same time measuring the annual allowance for the preparation of the budgets (Drury 106). One of the examples is that of the allowance for the budgeted consumption and expenditures, which have an impact in the balance sheet. The most important thing about the activity-based system is that every activity in the budget is accounted for.
Research also shows that in order for a business to manage the costs and minimize them, it is important to account for them in the budgets. The main objective of the system is ensuring that each activity in the accounting department has been managed and only the supply of those resources, which are important for the company, is accounted for. The system also dictates that the cost drivers are assigned to the products and objects, which reverse the whole process of budgeting. The resources in an organization are put into their most productive areas where they will bear more outputs than when they have been directed to a specific direction.
The activity bases system comes up with a model, which is used to manage programs such as activity based costing. This program entails the following stages, estimation of the available resources in the business usually done by volume or even the sales (Brigham and Ehrhardt). The demand of the organizational activities in an organization is also efficient in this process. The demand of a particular product in the market is a good measure to test its productivity, as well as the benefit obtainable from an organization or even a business entity. Thirdly, the management can also be able to estimate the quantity, which is needed to meet the market demand. The quantity is then weighed and the actual figures are then analyzed. Using the network diagram, it is then easier to know which path to follow to implement a program or even a project in the business entity (Drury 94).
Activity based accounting system will also be a solution to the accountants in future. The system is based on simple accounting stages, which help the personnel involve managing their time. Conventional budgeting is the first stage when using the system. This stage involves ordering and scheduling of products to respective customers. In order to implement this system, it is essential for the accountants to have a solution to their products and their respective requirements. All the receipts and orders are put in the system according to their respective manner and then analyzed accordingly.
Taxation laws
Prior to commissioning the business transactions, it will be essential for Genco to put into consideration the taxation laws applied within Malaysia. Most companies investing in foreign countries suffer a set back upon hurriedly making investments due to the attractive potential market while overlooking the taxes to be imposed on them. In such a scenario, the companies end up suffering financial losses as the monies accrued in the marketing of their products is taxed heavily by the governing authorities (Kubr 78). Malaysia just like the other territories around the globe, income made within the country by a state corporation, private company, or even individuals is subjected to tax. Moreover, Malaysia has even entered into various tax treaties with more than sixty-eight countries. The Act governing income taxation within Malaysia was introduced within 1967. Since 2009, companies running diverse business enterprises within the country were subjected to income tax deductions at the rate of twenty five percent. Genco falls under the category of companies and thus twenty-five percent of its yearly income will go to the Taxman. Since 2000, income tax assessment within Malaysia is undertaken on a yearly basis. Therefore, as much as Genco anticipates gaining a large market base within the country, it should review the effect of the taxes on its financial gains.
In the course of 2001, the Malaysian governing authorities were concerned with streamlining, as well as, modernizing the tax administration programs. In that endeavor, all companies are expected to carry out the self-assessment system. Under this program; companies are expected to file their tax returns with the Inland Revenue Board (IRB).The basic rule is that the payment of the tax figure achieved after the assessment should be made to the IRB prior to the expiry of thirty days since the assessment notice was issued. Penalties are imposed those who do not comply with that requirement. In order to avoid incurring unnecessary costs; Genco will be compelled to strictly adhere to that law. Therefore, prior to commencing their business transactions within the country, the firm should ensure that they possess qualified personnel who will be able to carry out the tax self-assessment in accordance to the Malaysian tax laws. It is also of great essence for the Genco management to note that, only the Real Property dealers who enjoy principal, gain taxes. However, since the start of April 2007 the government suspended the Real Property Tax Gains indefinitely.
Genco management should also be aware of the direct tax laws encompassing import duty along with excise duty applied within Malaysia. These previously mentioned taxes are imposed at a tax rate of the range of five percent to three hundred percent. Moreover, there is sales tax along with service tax, which will be imposed on the company at the rates of five percent to ten percent. The Genco financial department should be able to establish the effect of all these taxes on the projected revenue. In the event that the accrued revenue will be adversely affected by the aforementioned taxes, then it will be unnecessary to initiate the business transactions within the country in spite of the presence of a largely untapped market segment.
On top of the income taxes, as Genco will be involved with the production of drugs whose raw materials will be purchased outside Malaysia, then the firm will be required to pay import duty. The import duty is authorized by the 1967 Customs Act legislations. Basically, all imported goods are subjected to the duty while being cleared at the customs’ control points. The import duty rates are variable depending on the class of the imported goods in respect to the HS classification, that is, Harmonized System. In most of the cases, the rates are within the range of zero to two hundred percent.
Even though the import duty will be part of Genco’s liabilities, the imposed rates are considerably fair because they have been formulated in respect to the WTO (World Trade Organization) Valuation rules.
Foreign personnel along with immigration laws
Basically, the personnel who will be involved the production processes will mostly come from Genco’s headquarters. In order to gain entry to Malaysia, they will be required to meet the visa along with passport requirements. In accordance to the Malaysian immigrations laws, it is a must to possess either a passport or any other travel document recognized internationally which both should be valid in order to be legally allowed within the country. Moreover, those documents should have been valid for a minimum of six months period prior to entering Malaysia. Moreover, visa applications should be made within the nearby Malaysian embassies. The Genco management will be expected to meet the costs of all of the specified documents on behalf of its employees. These costs even though may seem insignificant will obviously have some impact on the initial capital cost of establishing the production facilities.
Concerning the use of foreign workforce within the country, the government insists that the local citizens should be given the first priority while dishing out any available jobs. However, in case there are no qualified Malaysians to fill up the positions, foreign firms are allowed by law to bring along expatriate personnel. Moreover, the foreigners are allowed to occupy senior posts within the management. This is allowed in the spirit of ensuring that the employment patterns within the country illustrate its multiracial composition. It is thus evident that the Genco management will not experience any obstacles in introducing the required expertise within the country. However, there will be some costs to be incurred in the training of local the native Malaysians because the personnel cannot be completely made of foreigners only.
The Malaysian government is also concerned with making the investment environment better, as well as, encouraging technology transfer. The expatriate personnel policy has been liberalized in order to improve the foreign skills inflow within Malaysia. The novel expatriate personnel employment guidelines were established in June 2003. Genco will be expected to set up production facilities, which fall under the category of foreign manufacturing companies whose capital cost is above two million United States dollars.
Companies under this category have their special regulations regarding the expatriate employment. In the first place, they are allowed to make use of a maximum of ten foreign employees. Besides, five of the ten are allowed to hold five principal posts (Kubr 63). It is in that regard that the Genco management has to formulate ways on how to limit the required foreign experts to ten. Firms within this category are also expected to retain the foreign employees holding the executive posts for a period of not more than ten years. Foreigners occupying the non-executive posts should not stay on the posts for more than five years. In that regard, Genco will be compelled to train the Malaysians such that they can fit in these positions upon the expiry of the specified timelines. In addition, the expatriates employed within the manufacturing sector should have a minimum of twenty-seven years. However, the ICT (Information and Communication Technology) sector is given an exception because individuals whose age is within the range of twenty-one years are permitted to pick various employment posts within their field (Allen and Tommasi).
Nevertheless, expatriate employees are required to request new work pass upon being transferred to other posts within the same firm. The initial employment pass shall be revised to indicate the alteration in post. Besides, the fresh expatriate taking up the vacant post should obtain a new employment pass. Every employment pass remains valid as per the aforementioned maturity days in respect to the post-occupied (Kubr 57). Nevertheless, expatriates holding executive posts are issued passes, which are renewable within a range of five years. However, in certain circumstances, there are exceptional situations within which this exception is not applicable. For instance, if the foreigner holds a passport, which expires within five years, the exception becomes dissolved. In addition, this exception cannot apply to foreigners whose contract will not even get to five years. Besides, the employing firm may sometimes not require the services of the foreigner for a period exceeding five years. The foreigners however enjoy the advantage of getting numerous entry visas, which are valid in relation to employment pass validity.
Conclusion
Given the findings of the report discussed above, it is clear that, there are several issues, which Genco ought to put into consideration before making the investment. Just like any company wishing to operate in any given nation, Genco should determine if its operations are legalized in Malaysia. Additionally, there are other issues such as taxation Laws, companies Act, mergers and acquisitions, contractual issues and foreign personnel along with immigration laws among other issues discussed in the report ought to be carefully considered. By ensuring that all factors are considered, Genco will ensure the success of the investment.
Works Cited
Allen, Richard, and Tommasi, Daniel. Managing Public Expenditure: A Reference Book for Transition Countries. Paris: OECD, 2001. Internet resource.
Aids or acquired immune deficiency syndrome is defined as a combination of symptoms and infections that results from low immunity caused by a virus known as HIV or the human immunodeficiency virus. However, researchers have argued that there are other factors that contribute to the same problem.
The condition increases individuals’ susceptibility to opportunistic infections as well as different types of tumors because it affects the immune system (Huether & McCance, 2007). In the view of the fact that HIV infection involves many cells in the body, its path physiology is complex and difficult to understand. Once the HIV virus enters the human body, it depletes CD4+ T helper cells thereby weakening the immune system which gives room to the opportunistic infections to develop.
HIV infection takes place in different phases. The first phase is known as the acute phase and is also referred to as the asymptomatic period. It is characterized by depletion of CD4+T cells which occurs after infected cells are killed by cytotoxic T cells as well as due to cell lysis which is induced by HIV.
In addition, the acute phase is also marked by apoptosis, a process of death of cells leading to elimination of cells. Chronic phase follows closely and it is marked by great decline of CD4 + cells caused by the failure of the immune system to make new T cells and by general effects of immune activation. It is important to note that despite the fact that symptoms are not observed immediately after infection, there is great loss of CD4+ cells in the intestinal mucosa which harbors a lot of lymphocytes.
The next phase is known as latent phase which occurs due to immune response meant to prevent further infection. Although the HIV life cycle is marked by depletion of CD4 cells, the body still manages to fight very dangerous opportunistic infections. Constant weakening of CD4+ cells which takes place in the acute phase affects mucosal barrier and the same lowers immunity further (Medic n.d ).
The last stage of HIV AIDS is characterized by emergence of opportunistic infections. The stage takes place after continuous depletion of CD4 + T cells. The situation does not only emanate from immediate killing of CD4 + T cells but also from the process of apoptosis. HIV also affects thymocyte and thereby reduces the ability of the thymus to produce new T cells (Huether & McCance, 2007).
Major classifications of drugs used to treat HIV and their impact the HIV life cycle
Antiretroviral drugs are used by HIV positive patients to improve their condition since effective cure of the disease has not yet been found. They are grouped in to five classes depending with the way they fight the HIV virus. Intergrase inhibitor like raltegravir reduces the chances of integration of viral DNA there by reducing the risk of infection. The next classification of entry inhibitors reduces the chances of HIV-1 virus entering the cell of human beings.
Nucleoside inhibitor prevents elongation of viral DNA by inhibiting reverse transcription. On the other hand, non nucleotide inhibitors prevent the replication of the HIV virus by interfering and preventing the action of the enzyme. Protease inhibitors were approved in the year 1995 to prevent the replication of the HIV virus by inhibiting the protease enzyme which helps in the same.
Each classification contains various drugs like zidovudine, lopinavir, lamivudine, efavirence, tenoforvir and ritonavir, to mention just a few (Medic n.d). Although all drugs are effective, their availability in different countries in the world is dependent on the resources the country has.
Opportunistic Infections
HIV victims are usually affected by infections as well as by malignancies known as opportunistic infections due to increased susceptibility. They usually suffer from diseases caused by bacteria like tuberculosis which is the most common. It is marked by persistent cough as well as by weight loss.
Although it is found virtually everywhere in the world, it mostly affects people in the developing countries. Cryptococcosis is also an opportunistic disease resulting from fungal infection. It mostly affects the brain and represents itself as meningitis or even as a pulmonary disease.
Herpes is also an infection common among HIV victims and is characterized by sores in the mouth and around the genital area. It is caused by a virus know as herpes zoster and although it is not fatal, it is extremely painful. There is yet another infection common in HIV victims identified as histoplasmosis. Its symptoms are inclusive of loss of weight, breathing difficulties, fatigue and fever. Although it is treatable, it can end up being fatal if not treated in time (Huether & McCance, 2007).
Finally, there is a disease known as toxoplasmosis which results from protozoan that exists in raw meat and also in the feaces of a cat. It affects the brain and can lead to vomiting, headache, fever, confusion and even coma. Failure to treat the disease can lead to other complicated diseases like the pneumonia.
More often than not, death of the HIV victims is caused by failure to treat the opportunistic infections. Therefore, HIV victims are advised to seek medical attention immediately they feel ill since there are many dangerous opportunistic infections beyond the scope of this paper.
References
Huether, S. E., & McCance, K. L. ( 2007). Understanding Pathophysiology. St. Louis : Mosdy.
According to the United States Agency for International Development (USAID) (2013), 1.6 million citizens in Kenya are infected with the Human Immunodeficiency Virus (HIV). Statistics by the Kenya National AIDS and STD Control Council (2012) indicate that the disease had affected about 6.2 percent of the population aged over 18 years in 2011. As a result of the high prevalence, the country is reported to have the fourth highest HIV burden in the world. Additionally, the high prevalence has affected the global burden of HIV and AIDS. Kenya is located in the Sub-Saharan region in Africa, which has the highest HIV and AIDS (70.9 percent) burden in the world (Amornkul, et al., 2009).
In reference to AVERT (2014), the HIV infections are generalized across this population. However, several groups within the Kenyan population have been reported to be more vulnerable to the infection. These groups include; men who have sex with men (MSM) (18.2 percent), women (6.2 percent), drug users (18.3 percent), and sex workers (29.3 percent) (Kenya National AIDS and STD Control Council, 2012). In reference to the homosexual population, Mombasa (24.5 percent) is reported to have the highest HIV prevalence in Kenya.
Although Kenya and Uganda are classified as high-HIV burden countries, the prevalence of the disease in Uganda is higher with 7.2 percent of the population being infected (AVERT, 2014). In addition, the prevalence of HIV in Kenya is extremely high compared to that of Latin America (0.4 percent). This is an indication of the global HIV variation patterns. In reference to Amornkul et al. (2009), the high burden of HIV and AIDS in Kenya is a hindrance toward bringing the global burden of the disease to zero.
Health Indicators
Hyder, Puvanachandra, and Morrow (2012) define health indicators as summary variables that determine the health of a community. Each indicator is an important measurement and it contributes to the overall health of a certain population. Public health discipline requires that these indicators be tracked over time to give a picture of the health of a population. Specifically, this gives the trends of the morbidity and mortality rates of a population. In reference to Hyder, Puvanachandra, and Morrow (2012), there are two main groups of health indicators that are crucial in defining the health of a community.
The first group is the health status indicators, which define various characteristics of the health care. These include; prevalence of chronic illnesses, infant mortality, and disability rates. The second group comprises of the health determinants which are correlates of health within the population and include; age, sex, and access to healthcare among others. Health indicators are used in ranking the health status of a community and are useful in making policies regarding health. In addition, such policies are determined by the profiles of both communicable and non-communicable diseases, and dynamic forces within a population. Health indicators must be based on evidence collected on disease patterns within the population for them to be measured effectively.
Globally, different regions have different health indicators that are used to define their health status ( Hyder, Puvanachandra, & Morrow, 2012). Such indicators affect the prevalence and incidence of diseases on a global scale as some countries are likely to have more disease burden compared to others. Furthermore, eliminating the global burden of diseases requires concerted efforts from individual countries. As a result of variations on the health determinations across countries, health indicators are likely to vary globally. The economic status of a country also causes variations of health indicators and this could explain why the health indicators used in developed nations are different from those used in less-developed countries. Health inequalities across different countries contribute to the global burden of diseases (World Health Organization, 2014).
There are various issues that health professionals from different countries need to address in an effort to promote positive health indicators. Such issues include; access to health facilities, ability of the health facilities to cater for the needs of the population, education and level of knowledge of diseases within the population, government commitment in lowering the country-specific burden of diseases, and amount of healthcare funding ( Hyder, Puvanachandra, & Morrow, 2012). According to the World Health Organization (WHO) (2014), four major health indicators are used to determine the burden of HIV and AIDS In the world. These include; prevalence of HIV among adults, use of condom and HIV and AIDS knowledge within a given population, Mortality rate from HIV and AIDS (per 100,000 population), and the coverage of Anti-Retroviral Therapy among patients with AIDS.
In Kenya, there has been evidence of positive HIV health indicators (Kenya National AIDS and STD Control Council, 2012). Specifically, the prevalence, incidence, and mortality rates have been on a downward trend since 2000. There are several health indicators that are used to profile the HIV situation in Kenya (World Health Organization, 2014). These include: prevalence of HIV among adults (0-49 years), number of citizens aged 0 to 49 years who are living with HIV and AIDS, number of HIV and AIDS patients on ARV’S, Number of facilities offering HIV testing and counseling services, level of knowledge regarding HIV and AIDS prevention, and Knowledge on condom use. However, the Kenya National AIDS and STD Control Council (2012) reports that these indicators seem to provide a mixed picture on the burden of HIV and AIDS in this population. While some measures seem to indicate that the rates of HIV are reducing, others give a contrary view.
Kenyan health system
In reference to Quaye (2010), the Kenya health care system has experienced major problems that have over the years hindered quality delivery of services to the people. Additionally, the widespread income inequality and low socio economic status of the population limits uptake of health care. Access to the basic health services by the people and the inability of the government to distribute these services to the entire population has contributed to the high disease burden in the country. The country has a total population of about 41 million and the health care system has been unable to cater for the needs of the entire population.
Moreover, there is a major divide between the rural and urban regions in the country with majority of the services being concentrated in the urban regions. The slum areas located in the urban regions also experience inequality in health service delivery and massive poverty. Chuma and Okungu (2011) explain that the health care system of Kenya constitutes of both public and private health facilities. Access of health services in these facilities is determined by the level of income of an individual.
Chuma and Okungu (2011) indicate that the public sector comprises of the Ministry of Health (MOH), which is the policy-making organ on health matters. The public healthcare system encompasses five levels of health facilities. These include; national referral facilities, county hospitals, district facilities, health centers and dispensaries. The national referral facilities are few, contain state of the art diagnostic services, and cater for the low and high income earners. Majority of the private health centers are extremely expensive and only high-income earners can afford the services.
Chuma and Okungu (2011) also note that the national referral centers are distributed unequally across the population. In this view, there is limited access to these facilities by some individuals in the population. The health centers and dispensaries are only involved in the provision of primary care and lack advanced diagnostic services. Quaye (2010) indicates that health professionals tend to be more concentrated in the urban areas compared to the rural areas. Thus, majority of the disease burden in the population has been recorded in the rural areas.
Another challenge facing the system is the lack of medical supplies in some of the rural facilities (Chuma & Okungu, 2011). The Kenyan government has over the years been unable to standardize the cost of health care making it only available to the few citizens who are financially able. In semi-arid regions like Wajir district, individuals have to walk for long distances to access health care. According to the Kenya National AIDS and STD Control Council (2012), the limited access to healthcare and poor infrastructure in some regions has affected the uptake of Voluntary Testing and Counseling (VCT) services in HIV prevention. As a result, the incidence of HIV in some of these areas is high.
Furthermore, most rural populations lack access to education regarding the prevention of HIV and condom use. The lack of medical supplies in some facilities affects ART coverage and thus increasing the mortality and morbidity rates of HIV and AIDS. The Kenya National AIDS and STD Control Council (2012) also indicate that the limitation in the health system has led to an increase of mother to child transmission of HIV. This is because these mothers tend to deliver at home and hence increasing the probability of infecting their children with HIV.
The WHO (2015) defines health determinants as factors that influence the health of a population. These determinants vary across regions. The environment for example, is a major determinant of health in many settings. Other determinants of health include; socio demographic factors, level of education, level of income, genetics, and social support networks among many others. Access and utilization of health services are also classified as determinants of health. According to WHO (2015), the backgrounds of populations determines whether they are healthy or not. In addition, majority of the determinants of health cannot be controlled directly by the communities. In this view, different regions around the world exhibit different health determinants and thus variations in the health status.
In Kenya for example, majority of the population lives below the poverty line and hence affecting their health and burden of disease. It would be difficult to equate the health status of Kenya to that of the United States, which is more developed. Provided the health determinants of a certain country continue to increase the burden of disease, the global disease will continue to be high. In conclusion, the Kenya National AIDS and STD Control Council (2012) notes that the major limitations to lowering the prevalence of HIV in Kenya have been poverty and limited access to health services.
References
Amornkul, P. N., Vandenhoudt, H., Nasokho, P., Odhiambo, F., Mwaengo, D., Hightower, A.,… De Cock, K. M. (2009). HIV Prevalence and Associated Risk Factors among Individuals Aged 13-34 Years in Rural Western Kenya. PLoS ONE, 4(7), 1-11. Web.
Chuma, J., & Okungu, V. (2011). Viewing the Kenyan health system through an equity lens: implications for universal coverage. International Journal for Equity in Health, 10(22), 1-14. Web.
Hyder, A. A., Puvanachandra, P., & Morrow, R. H. (2012). Measuring the health of populations: explaining composite indicators. Journal of Public Health Research, 1(35), 222-228. Web.
Kenya National AIDS and STD Control Council. (2012). The Kenya AIDS epidemic: Update 2012. Web.
Quaye, R. (2010). Balancing public and private health care systems: The Sub-Saharan Africa experience. Lanham, Maryland: University Press of America. Web.
United States Agency for International Development. (2013). USAID Kenya HIV/AIDS. Web.
WHO. (2015). Health Impact Assessment (HIA): The determinants of health. Web.
World Health Organization. (2014). Global Health Observatory Data Repository. Web.
One of the most important processes in the provision of health care services is the effective communication of health information (Ratzan, 2014). This involves sharing medical information with patients, health care professionals, and creating public awareness through campaigns. Health campaigns play a pivotal role in achieving effective management of diseases because people get an opportunity to learn numerous things about a certain illness (Stolley, & Glass, 2009).
The most important element that one should consider when developing a health campaign is the slogan. This is the catchword or phrase that defines the objective of running a campaign to sensitize people about a specific disease (Ratzan, 2014). Developing a campaign slogan for Human Immunodeficiency Virus (HIV) /Acquired Immune Deficiency Syndrome (AIDS) is complex and requires careful consideration with regard to the interplay of factors that characterize its propagation (Stolley, & Glass, 2009).
A good example of a slogan for an HIV/ AIDS campaign is Hate the Disease, not the Diseased. The reason this slogan would be effective in running a health campaign for this kind of illness is that it touches on one of the main factors that have affected its effective management. One of the challenges associated with HIV/AIDS is the stigmatization of people living with health conditions. It involves verbal, physical, and emotional abuse from family members, friends, and the community (Ratzan, 2014).
These are some of the factors that influence the development of this slogan. Studies have established that anybody can be affected by this condition, thus no need to stigmatize those already living with it. People can contract HIV unknowingly through various ways that are at times beyond human control (Stolley, & Glass, 2009). For example, this can happen in an accident scenario or through the failure of contraceptives such as condoms.
Another factor that influenced the development of this slogan is the fact that most cases of stigmatization against people living with HIV/AIDS develop because people lack knowledge and education about the health condition (Stolley, & Glass, 2009). For example, some people believe that they can contract the disease by shaking hands with an infected person or even being in the same room with them. One of the main things considered when developing this slogan was the fact that most people tend to worry a lot about associating with people living with the disease yet they do not have essential information about it. There is an urgent need for people to develop hatred towards the disease and learn various ways of keeping themselves safe from contracting it (Ratzan, 2014).
Some of the communication channels for this kind of health campaign include the use of mass media, social media, workshops, traditional channels such as billboards, and sporting events (Stolley, & Glass, 2009). Mass media has the potential to reach a lot of people through various radio and television programs. Social networking sites are also an effective strategy for communication owing to the fact that many people, especially the young, use the internet a lot for various reasons (Ratzan, 2014).
Billboards and workshops are effective means of communication because they will convey the intended message to a lot of people. Sporting events are also effective because they help to bring people together for a common cause (Ratzan, 2014). Organizing such events with a health-related theme helps in increasing people’s awareness about a certain illness. Some of the potential barriers to this kind of campaign include misinformation, lack of cooperation from involved stakeholders, misguided perceptions, and financial challenges (Ratzan, 2014).
References
Ratzan, S.C. (2014). Aids: Effective Health Communication for the 90s. New York: Routledge. Web.